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 City of Wheat Ridge requires that customers entering critical businesses cover their nose and mouth by wearing a mask or other form of facial covering effective April 27 – May 30, 2020. To assist critical 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 are still in the process of acquiring a facial covering. These masks are not the N95 type of masks used by medical personnel treating patients with COVID-19 but do provide better filtration and fluid protection. These masks are not the same masks being used by healthcare workers and first responders, and are readily available through normal distribution channels. Masks are only to be provided to customers of critical businesses who do not have a mask or other form of facial covering.

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 will be provided with deliveries by City staff. City staff will deliver masks beginning the week of May 11, 2020. Any business who runs out of masks may submit another request for additional 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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