Pennsylvania Manufacturing Call to Action Portal

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Please note all text boxes in this form are limited to 500 characters. Please provide additional information as attachments, if necessary.
Attachments added are shown at the bottom of the page.

Company Name *
Facility Address 1 *
Facility Address 2
Facility City *
Facility State *
Facility County *
Facility Zip *
Contact First Name *
Contact Last Name *
Contact Title/Position *
Contact Email *
Confirm Email *
Contact Phone Number *
Company Website
NAICS Code (if known)
Manufacturer of EndUser COVID-19 Related Product (Direct to Market)
Manufacturer of COVID-19 Related Input/Component Product (Supply Chain)
Distributor of EndUser COVID-19 Related Product (Logistics)
Distributor of COVID-19 Related Input/Component Product (Logistics)
Other COVID-19 Related Product Supply Chain Partner (Testing, Packaging, etc.)
Currently Non-COVID-19 Related Manufacturer Willing to Re-Tool Operations for the Following:
Specific COVID-19 Related Product(s) being manufactured/distributed?
Are you currently experiencing supply chain constraints or pinch points?
Are you willing to outsource manufacturing, assembly or other operations to alleviate supply chain or production pinch points?
Does your current labor force allow you to meet your increasing demands?
Will you need to increase shifts to accommodate the demand in operations?
Please identify the items you believe your company can re-tool to supply
Please describe other innovations
What qualifications does your company currently have to produce the needed supplies?
Are you currently operating as a Life Sustaining Business or have you received a Waiver to continue operation of your facility?
Please list any certifications or registrations for your company and/or facility and the products you can supply, produce or provide.
Please let us know if there are any barriers to your success in manufacturing these products at your fullest capacity.
Internal Comments
Additional Info
Case Manager Grp