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					                                                               POD Site Supply List attachment 17
                                                                          POD SOG
                                                                           061005
             POD Site Supply List (Excluding                Please place a check  If your county does    Where will this item be   Will this item If this item needs to be
                                                                mark in the        not have this item,         stored?               need to be    distributed, describe
             pharmaceutical and other durable       appropriate box to               is your county                                distributed to  how this item will be
           medical equipment included in the SNS) indicate whether or not              planning on                                 the POD site transported to the POD
                                                            your county currently obtaining this item                                 from the               site?
                                                              YES         NO          YES        NO           LOCATION              YES      NO    Distribution Process
          SET-UP
          List of emergency phone numbers
          Name badges
          Sign-in sheets for patients
          Sign-in sheets for staff
          Signs directing flow of traffic
          Signs to mark way to restrooms
          Staff vests
          Option (in place of listed item)
          Other (Please describe and add as many rows as
          needed to complete this)
          Patient Registration/Consetn/record
          Station Identification Signs

                                                                               OFFICE SUPPLIES
          3-ring Binder
          Any applicable site evacuation plans/procedures
          Boxes for collecting forms(1)
          Calculator
          Clipboards (1)
          Colored markers
          Copy Paper
          Easel Paper-includes stand
          Envelopes - interoffice
          Envelopes - letter size
          File Folders
          Highlighter
          Job action sheets
          Manual 3 Hole Punch
          Markers
          Masking Tape
          Paper Clips - jumbo
          Paper Clips - standard
          Paper tablets
          Pencil Sharpener
          Pencils
          Pens
          Photocopy machine
          POD site maps with clinic flow diagrams
          Post-it Notes 3"x3"
          Rubber Bands
          Scissors
          Scotch Tape
          Stapler
          Staples
          Thumbtacks
          Whiteout
          Option (in place of listed item)
          Photocopy Paper (assorted colors)
          Photocopy Paper (white)
          In-boxes
          Push Pins
          Other (Please describe and add as many rows as
          needed to complete this)
          Binder Clips (assorted sizes)
          Colored Dots
          English Spanish Dictionary
          File Totes
          First Aid Kit
          Medical Dictionary
          Photocopier Toner Cartridge
          Poster Board
          Record Book

                                                                     GENERAL SUPPLIES & EQUIPMENT
          All-purpose cleaner
          Batteries (double AA, C's,D's)
          Battery-operated radio weather band
          Biohazard bags
          Bleach
          Bottled water
          Caution tape (1)
          Chairs
          Cots, blankets, pillows
          Electric lantern
          Facial tissue
          Flashlight
          Flashlight batteries
          Food and drink for staff
          Hand cleanser (alcohol based) (1)

                                                                                   Attachment 17
(rev. 12/28/04)                                                                                                                                                              1 of 3
                                                                     POD Site Supply List attachment 17
                                                                                POD SOG
                                                                                 061005
             POD Site Supply List (Excluding                      Please place a check  If your county does    Where will this item be   Will this item If this item needs to be
                                                                      mark in the        not have this item,         stored?               need to be    distributed, describe
             pharmaceutical and other durable       appropriate box to                     is your county                                distributed to  how this item will be
           medical equipment included in the SNS) indicate whether or not                    planning on                                 the POD site transported to the POD
                                                                  your county currently obtaining this item                                 from the               site?
                                                                    YES         NO          YES        NO           LOCATION              YES      NO    Distribution Process
          Lantern battery
          Liquid hand soap
          Orange cones for traffic flow (1)
          Paper cups - Styrofoam
          Paper napkins
          Paper to cover table
          Paper towels
          Safety pins
          Screens(1)
          Spray bottles
          Tables
          Toilet tissue
          Tool kit
          Trash bags
          Option (in place of listed item)
          Other (Please describe and add as many rows as
          needed to complete this)
          AV Cart
          Batteryless Flashlights
          Clear Plastic Storage Boxes (assorted sizes)
          Clock (large battery operated)
          Duct Tape
          Free Standing Light Set
          Hagstrom Maps
          Ice Packs
          Industrial Extension Cords (50ft)
          Industrial Hand Cart
          Industrial Surge Protectors
          Packing Tape and Dispenser
          Portable Generator
          Portable Indoor/Outdoor Retractable Stanchions
          Portable TV with VCR/DVD
          Replacement Light Bulbs for Light Sets
          Posts and chains
          2-Way Radios
          Storage Coolers

                                                                                    MEDICAL SUPPLIES
          2-way CPR mask
          Alcohol wipes
          Antibacterial hand washing solution
          Aspirin, Tylenol
          Bandages
          Blood pressure cuffs-small, medium, large, extra-
          large
          Cotton Balls
          CPR Face Masks
          Emesis basins
          Gauze 2x2
          Gloves - non-latex/powder free/assorted sizes
          IV Start kits
          IV tubing
          Spill Kits
          Protective Eyewear
          Masks (general, N-95)
          Medicine cups
          Normal Saline
          Paper gowns
          Adult Scales
          Pediatric Scales
          Medication/vaccine refrigerator
          Pen lights
          Plastic Bags-dispensing meds for home
          Regular Insulin, D50
          Sharps Containers
          Stethoscopes
          Surgical Tape
          Privacy Screens

          Syringes (3cc, tuberculin syringes, insulin syringes)
          Thermometers and probe covers
          Tongue depressors
          Tourniquets
          Wheelchairs
          Option (in place of listed item)
          Micropore Paper Tape
          Millipore Tape
          Other (Please describe and add as many rows as
          needed to complete this)
          Band-Aids
          Biohazard Waste Tape
                                                                                         Attachment 17
(rev. 12/28/04)                                                                                                                                                                    2 of 3
                                                                    POD Site Supply List attachment 17
                                                                               POD SOG
                                                                                061005
             POD Site Supply List (Excluding                     Please place a check  If your county does    Where will this item be   Will this item If this item needs to be
                                                                     mark in the        not have this item,         stored?               need to be    distributed, describe
             pharmaceutical and other durable       appropriate box to                    is your county                                distributed to  how this item will be
           medical equipment included in the SNS) indicate whether or not                   planning on                                 the POD site transported to the POD
                                                                 your county currently obtaining this item                                 from the               site?
                                                                   YES         NO          YES        NO           LOCATION              YES      NO    Distribution Process
          Biohazard Waste Bags
          Biohazard Waste Boxes
          Blood pressure cuffs-small, medium, large, extra-
          large
          Chucks
          Control of Communicable Disease Handbook
          Disposable emesis bags
          Disposable lab coats
          Eye Protection or Face Shields
          Harriet Lane Handbook
          Harrison's Book of Interanal Medicine
          Paper Drapes
          Cold/hot packs
          Pill Bottles
          Pill Bottle Labels
          Pill Counters/Spatulas
          Physicians Desk Reference Manual

                                                                                 EMERGENCY SUPPLIES
          AED (automatic external defibrillator)
          Ammonia
          Ampules of diphenhydramine (50mg/ml)
          CPR face masks
          Emergency drug dosing charts
          Epinephrine 1:1000 SQ or EPI PEN adult/child
          Option (in place of listed item)
          Other (Please describe and add as many rows as
          needed to complete this)
          Oxygen tank
          Oxygen Tubing
          Pillow
          Cot
          Blanket

                                                                                POD COMMUNICATIONS
          Backup internet connection
          Bullhorn
          Computer cable (25 ft. or longer)
          Digital camera
          Fax capability or Fax machine
          Internet Access: Dial up or wireless connection as a
          minimum (if within range)
          Land line phone connection, cordless headsets
          Laptop or desktop with software loaded
          Large screen video setups with VCRs or DVD
          players to show educational videos
          Long phone cord (25 ft. or longer)
          Phone backup – cell (if within range) or satellite;
          pager(s)
          Printer(s)
          Radio (VHF/UHF)
          Telephones
          Walkie talkies
          Option (in place of listed item)
          Plain Paper Fax Machine
          Other (Please describe and add as many rows as
          needed to complete this)
          Batteryless AM/FM Radio
          Blank CDs
          Fax Machine Ink Cartridges
          Formatted Floppy Disks
          Jewel Cases (for CDs)
          Printer Ink Cartridges

                                                                              EDUCATIONAL MATERIALS
          (1) Small supply on hand
          Consumer question and answer sheets specific to
          BT event
          Educational Videos
          Option (in place of listed item)
          Other (Please describe and add as many rows as
          needed to complete this)
          Patient Drug Information sheets ( available in 48
          languages from CDC )




                                                                                        Attachment 17
(rev. 12/28/04)                                                                                                                                                                   3 of 3

				
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