Sources of Funds for acquiring respirators in your hospital.
Select the rank for each Source of Funds where 1 = most funds will come from here, 5 = least funds will come from here.

Grant Money 1 2 3 4 5 *

Hospital Budget 1 2 3 4 5 *

Expenses 1 2 3 4 5 *

Donations 1 2 3 4 5 *

Leasing 1 2 3 4 5 *

Others 1 2 3 4 5

Others - Specify

In the future, will your hospital look towards this source of funds

Grant Money More Less *

Hospital Budget More Less *

Expenses More Less *

Donations More Less *

Leasing More Less *

Others More Less

Others - Specify

For N95 Mask Respirators that you currently use in your hospital

Used for Emergency Preparedness Check if used here
Will increase use here in future
Will decrease use here in future
*

Used for suspect and confirmed patients in isolations rooms (Med/surge and ICUs) Check if used here
Will increase use here in future
Will decrease use here in future
*

Used in the Emergency Department Check if used here
Will increase use here in future
Will decrease use here in future
*

Used for Bronchoscopy and other high risk aerosolizing procedures Check if used here
Will increase use here in future
Will decrease use here in future
*

Used for Operating Room Check if used here
Will increase use here in future
Will decrease use here in future
*

Used for Laboratory Check if used here
Will increase use here in future
Will decrease use here in future
*

Other Areas of Use - Please Specify

Preferred N95 Mask Respirators

Preferred N95 Brand *

Preferred N95 Model *

N95 Advantages
Select the rank for each characteristic - 1 is highest and 5 is lowest

What are the top three ways your preferred N95 brand helps your hospital? *

For PAPR Respirators that you currently use in your hospital

Used for Emergency Preparedness Check if used here
Will increase use here in future
Will decrease use here in future
*

Used for suspect and confirmed patients in isolations rooms (Med/surge and ICUs) Check if used here
Will increase use here in future
Will decrease use here in future
*

Used in the Emergency Department Check if used here
Will increase use here in future
Will decrease use here in future
*

Used for Bronchoscopy and other high risk aerosolizing procedures Check if used here
Will increase use here in future
Will decrease use here in future
*

Used for Operating Room Check if used here
Will increase use here in future
Will decrease use here in future
*

Used for Laboratory Check if used here
Will increase use here in future
Will decrease use here in future
*

Other Areas of Use - Please Specify

Preferred PAPR Mask Respirators

Preferred PAPR Brand *

Preferred PAPR Model *

PAPR Advantages
Select the rank for each characteristic - 1 is highest and 5 is lowest

What are the top three ways your preferred PAPR brand helps your hospital? *