Montana Immunization Program Freezer Temperature Log
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3Montana Immunization Program
Freezer Temperature Log
Month/Year______________ Storage Unit____________ Provider ___________________________________VFC#_________
Routine Temperature Monitoring– Record:
Out-of-Range Response: If temperatures (other than defrost cycles*) are in
Time of day and Initials of staff recording temperatures
the shaded zone or the data logger light is red:
Quarantine vaccine, label DO NOT USE, and store under proper
Is light green? (Y or N)
AM: Record current temperature with an X, and minimum (▼) and
temperatures, if possible.
Contact the Immunization Program by going to
maximum (▲) temperatures each with an M. Reset min/max by holding
and clicking on “Vaccine Incident Report.”
the button down until “CLR ▲▼” appears (3–5 seconds).
PM: Record current temperature with an X. Is light green? (Y or N)
Questions? 444-5580 hhsiz@mt.gov.
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Day of Month
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
Time of Day
Staff Initials
Light Green?
≥11°
10°
9°
DO NOT USE vaccine that has been stored at these temperatures (shaded grey). See instructions at top of page.
*Frost-free freezers can have out-of-range maximums as long as the light is green.
8°
7°
(C)
6°
5°
4°
3°
2°
1°
0°
-1°
-2°
-3°
-4°
-5°
-6°
-7°
≤-8°
MT IZ VFC Form 217.5 (revised 12/15/2014) Retain temperature logs for three years.
Download temperature logs at: .
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