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- Badger Tactical
Staffing Solutions
- Temporary Staffing
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AED Wholesale

My Dashboard
My Courses
My Account
Log In

My Dashboard
My Courses
My Account
Log In

Search for:

Search

Home
Courses
Calendar
About
- Contact
- Badger Tactical
Staffing Solutions
- Temporary Staffing
- Standby EMS
AED Wholesale

My Dashboard
My Courses
My Account
Log In

FACILITY PROFILE

Facility Point of Contact *

First

Last

Phone Number *

Email *

Position/Job Title

Facility Name: *

Facility Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is you facility currenlty experiencing a COVID-19 outbreak? *

Yes
No

Onsite Parking:

Yes
No

Facility Type: *

Assisted Living Facility
Adult Family Home
Skilled Nursing/ Nursing Home
Supported Living Agency
Enhanced Supportive Facility
Other

Please Note: Mask fit testing will be at cost to your facility. *

I Agree

Do you have a supply of N95?: *

Yes
No

Does facility have a respiratory protection program? *

Yes
No

Medical Evaluations: Columbia Safety can provide onsite medical evaluations to Adult Family Homes (AFHs) and facilities experiencing a COVID-19 Outbreak at the time of the appointment. ALL OTHER FACILITIES ARE REQUIRED TO COMPLETE MEDICAL EVALUATIONS PRIOR TO SCHEDULING AN APPOINTMENT. This may be completed within your facility or using a third party option such as 3M Online Respirator Medical Evaluations *

I HAVE READ AND ACKNOWLEDGE THE REQUIREMENTS FOR MEDICAL EVALUATIONS

If you do not have a 3M account or do not have access to your existing account, would you like to have one set up for your facility? (There will be no cost to you or your facility) *

I have access to my account
Please create an account for me
I don't need an account

If you don't plan to use 3M and are not eligible for onsite medical evaluations, how will medical evaluations be conducted prior to fit testing? *

Please Select: *

Testing
Training

*May choose both

During the training process, you and/or some of your employees will be trained to perform your own mask fit testing. If you are not interested in learning to do your own fit testing please select the testing option only.

I Agree

How many people are testing? *

How many people are training? *

How many people are testing? *

15-19
20-29
30-39
40-49
50-59
60-69
70-79
80-89
90-100

Do you Have A Fit Test Kit: *

Yes
No

Kit Brand: *

Allegro
3M
Other

Other *

Solution Type: *

Sweet
Bitter

How Many Kits? *

Where Will Testing Occur Within Facility: *

(Example: Dinning Hall, Conference Room, etc.). Space must be large enough to accommodate the number of people testing, and 2-3 Columbia Safety employees. Large groups will be split into 8 people testing at a time.

Cancellation Fee: 25% of the minimum charge if less than 48 hours before date of appointment. *

I Agree

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