Vaccine Refrigerator Temperature Log - Celsius Page 4
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4VACCINE STORAGE TROUBLESHOOTING RECORD
Use this page to record the details of the vaccine storage incident, including when the vaccine incident report was submitted to the state and the results of the incident (such as vaccine was viable
or still usable or the vaccine had to be wasted). The vaccine incident report must be completed and a copy kept in your records. The vaccine incident report is in I-CARE under reports, VFC
warehouse forms or on the home page under immunization links.
DATE OF INCIDENT
REPORTED BY
DATE REPORTED TO IDPH
TEMPERATURE EXCURSION
RESULTS OF INCIDENT
(Vaccine viable, vaccine wasted, unit repaired or replaced)
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