Wheat Ridge Face Mask Request Form

2. To protect the safety of employees, customers, and residents and to slow the spread of COVID-19, the Govenor has mandated that face masks be worn whenever residents are not in their own homes. To assist businesses and protect the community’s most vulnerable residents, the City is providing a limited supply of disposable masks for workers to hand to customers who arrive without one. These masks are not the N95 type of masks used by medical personnel treating patients with COVID-19 but do provide filtration and fluid protection.

4. Due to limited quantities being provided to Wheat Ridge businesses, businesses should only provide masks for those entering without one. Best practices for mask distribution and sanitation along with signage will be provided with mask deliveries by City staff. Any business may submit a request for masks. For questions, email Steve Art, sart@ci.wheatridge.co.us

6. Name of Business*

7. Contact Name*

9. Type of Business*

11. Business Address*

12. City*

14. State*

15. Zip Code*

16. Phone Number

18. Business Email*

20. Business Web URL

22. Estimated customer traffic per week *

24. Reply Email

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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