Vaccine Temperature Log For Refrigerator - Fahrenheit Page 3
ADVERTISEMENT
1
2
3
4Temperature Log for Refrigerator — Fahrenheit
F
Month/Year:___________________ Days 16–31
º
Take Action!
Completing this temperature log: Check the temperature in the freezer com-
If temperature is too warm (above 46
F) or too cold (below 35
F):
o
o
partment of your vaccine storage unit at least twice each working day. Place an
1. Store the vaccine under proper conditions as quickly as possible.
“X” in the box that corresponds with the temperature, the time of the tempera-
2. Temporarily mark exposed vaccine “do not use” until you have verified
ture reading, and your initials. Once the month has ended, save each month’s
whether or not the vaccine may be used.
completed form for 3 years, unless state or local jurisdictions require a longer
3. Call the immunization program at your state or local health department
time period.
and/or the vaccine manufacturer to determine whether the potency of the
If the recorded temperature is warmer than 46ºF or colder than 35ºF: this
vaccine(s) has been affected: (_______) ______________________.
take action!
represents an unacceptable temperature range. You must
4. Document the action taken on the reverse side of this log.
Staff Initials
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day of Month
Room Temp.
Exact Time
am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm
am pm
*Write any unacceptable
temps (above 46
F or below
o
35
F) on these lines.
o
Then take action!
Danger! Temperatures above 46ºF are too warm!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
46ºF
45ºF
44ºF
43ºF
42ºF
41ºF
40ºF
39ºF
38ºF
37ºF
36ºF
35ºF
Danger! Temperatures below 35ºF are too cold!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Adapted with appreciation from California Department of Public Health
See back for “Vaccine Storage Troubleshooting Record”
• Item #P3037F (8/11)
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • • •
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Miscellaneous