Trucking Summit Delegate Application

Please complete the below form to apply for the Summit. Make sure to complete the entire form and then click the blue "Continue" button. Please feel free to call Katie Sieracki at 847-423-2991 with any questions. We look forward to reviewing your application!

Event: IP Directors Summit
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Please tell us about your organization:

How many beds are in your facility?

How many patients are you responsible for?

Tell us about your hospital and the community it serves (2-4 sentences).

Tell us a little about yourself - your background, years in the industry and your current scope of responsibility (2-4 sentences). Sports fan, pet owner or cooking enthusiast? Tell us that too!

What is currently going well in your infection prevention department?

What keeps you up at night regarding your department?

If you could ask a room full of your peers a question or two about their department, what would you ask?

What other IP Directors or facilities would you recommend we include in the Summit?


PROCUREMENT PLANS:

Are you responsible for the selection or recommendation of products and services for your department?

Infection Test Kits: What is your department's projected need?

Room cleaning systems (UV, air, etc.): What is your department's projected need?

Disinfectants and Sterilants: What is your department's projected need?

Wound Care/Bandages/Dressings: What is your department's projected need?

Antimicrobial Stewardship Initiatives: What is your department's projected need?

Catheter and IV-related Supplies: What is your department's projected need?

Cleaning Equipment and Supplies: What is your department's projected need?

Handwashing Systems/Hand Hygiene Monitoring: What is your department's projected need?

Hand Sanitizers: What is your department's projected need?

Needlestick/Sharps Safety Devices What is your department's projected need?

Protective Wear: What is your department's projected need?

Sterile Processing and Decontamination Equipment: What is your department's projected need?

Asset Tracking/RFID Systems: What is your department's projected need?

Cleaning Verification/Testing Devices: What is your department's projected need?

What are your department's software needs in the next 6 to 18 months (data analytics programs, patient communication systems, etc.)?

Is your facility considering new building materials with antimicrobial abilities to help in fighting Healthcare Acquired Infections (HAIs)? Will you be updating your facilities over the next 6 to 18 months?

Please tell us about any other acquisition plans over the next 6 to 18 months.

Please list 2-5 products or service companies you would like to learn more about.

Do you work with any GPOs? Are you part of an IDN? If so, which one(s)?

I agree: If I am selected to attend the IP Directors Summit, I agree to be present for all sessions, meetings and functions while at the event.

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