Temperature Log for Refrigerator

If you have a vaccine storage issue, also complete “Vaccine Storage Troubleshooting Record” found on page 3.
Temperature Log for Refrigerator – Fahrenheit
Page 1 of 3
DAYS 1
15
Monitor temperatures closely!
1. Write your initials below in “Staff Initials,” and note the time in “Exact Time.”
2. Record temps twice each workday.
3. Record the min/max temps once each workday—preferably in the morning.
4. Put an “X” in the row that corresponds to the refrigerator’s temperature.
5. If any out-of-range temp, see instructions to the right.
6. After each month has ended, save each month’s log for 3 years, unlessstate/local
jurisdictions require a longer period.
Take action if temp is out of range—too warm (above 46ºF) or too cold (below 35ºF).
1. Label exposed vaccine “do not use,” and store it under properconditions as quickly as possible.
Do not discard vaccines unlessdirected to by your state/local health department and/or the
manufacturer(s).
2. Record the out-of-range temps and the room temp in the “Action” area on the bottom of the log.
3. Notify your vaccine coordinator, or call the immunizationprogram at your state or local health
department for guidance.
4. Document the action taken on the “Vaccine Storage Troubleshooting Record” on page 3.
Month
/
Year VFC PIN or other ID #
Facility Name
F
°
Day of Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Staff Initials
Exact Time
Min/Max Temp
(since previous reading)
Danger! Temperatures above 46ºF are too warm! Write any out-of-range temps and room temp on the lines below and call your state or local health department immediately!
46
˚
F
45
˚
F
44
˚
F
43
˚
F
42
˚
F
41
˚
F
40
˚
F
39
˚
F
38
˚
F
37
˚
F
36
˚
F
35
˚
F
Danger! Temperatures below 35ºF are too cold! Write any out-of-range temps and room temp on the lines below and call your state or local health department immediately!
Write any out-of-range
temps (above 46ºF
or below 35ºF) here:
Room Temperature
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
acceptable temperaturesaction
Aim for 40
º
Technical content reviewed by the Centers for Disease Control and Prevention
Immunization Action Coalition
1573 Selby Avenue
St. Paul, MN 55104
651
-
647
-
9009
Adapted with appreciation from California Department of Public Health
distributed by the
Page 1/9
Edit Online
Free Download

Temperature Log for Refrigerator PDF

Favor this template? Just fancy it by voting!
  •  
  •  
  •  
  •  
  •  
(0 Votes)
0.0
Related Forms
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 1019 Views | 19 Downloads
  •  
  •  
  •  
  •  
  •  
39 Page(s) | 6483 Views | 20 Downloads
  •  
  •  
  •  
  •  
  •  
11 Page(s) | 3618 Views | 11 Downloads
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 1121 Views | 14 Downloads
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 1566 Views | 19 Downloads