Fº Refrigerator Temperature Log Four Steps to Protect Your Vaccines Example 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Time 8:00 4:00 a.m. p.m. VFC PIN Step 2 Record the Time and your Initials. Day of Month Refrigerator Location Refrigerator ID Avoid patient recalls by accurately recording temperatures twice a day. Step 1 Month/Year (Days 1-15) Initials NN TP Step 3 • Record CURRENT, MIN, and MAX temperatures. Follow steps for one of the three ranges. • Circle if TOO WARM or TOO COLD. Refer to ranges. CURRENT MIN MAX 36.4 46.7 31.0 39.2 40.2 48.3 a.m. p.m. a.m. p.m. a.m. p.m. a.m. TOO WARM! 54º & warmer 53º 52º 51º 50º 49º 48º 47º 46.1º p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. MAX TOO WARM? 1. Press MEMORY CLEAR/RESET button. 2. Post “Do Not Use Vaccine” sign. 3. Alert your supervisor. 4. A.M. – Call VFC Call Center, or P.M. – Wait 1 hour: • If CURRENT is still TOO WARM, call VFC Call Center. • If CURRENT is OK, no need to call VFC Call Center. 5. Document on Step 4 (next page). OK 46.0º 45º 44º 43º 42º 41º 40º 39º 38º 37º 36º 35.0º TOO COLD! 34.9º 34º 33º 32º 31º 30º 29º 28º & colder CURRENT, MIN, and MAX are all OK. 1. Press MEMORY CLEAR/RESET button. Done. Skip Step 4 (next page). MIN TOO COLD? 1. Press MEMORY CLEAR/RESET button. 2. Post “Do Not Use Vaccine” sign. 3. Alert your supervisor. 4. At any time – Call VFC Call Center. 5. Document on Step 4 (next page). When Log Is Complete Sign and Acknowledge. File and keep log for 3 years. I certify that the temperatures recorded on this log are correct. All temperatures that were TOO WARM or TOO COLD have been circled and corrective action was taken and documented. I understand that falsifying logs will result in vaccines being unusable, patients being revaccinated, and provider possibly replacing vaccines. Staff Names and Initials: On-site Supervisor’s Name & Signature: California Vaccines for Children Program Date: VFC Call Center: 1-877-243-8832 EZIZ.org IMM-1125 Page 1 (12/14) Fº Refrigerator Temperature Log Month/Year (Days 1-15) Refrigerator Location Refrigerator ID VFC PIN Step 4 Document actions for temperatures that are TOO WARM or TOO COLD. TOO WARM Date & Time Incident MIN temp. 31.0, too cold. Example Thermostat set too cold. Temps went up during Example inventory when doors were opened a lot. 54º & warmer 53º 52º 51º 50º 49º 48º 47º 46.1º Called VFC? TOO COLD Corrective Action Yes Called VFC and manufacturers, adjusted thermostat to warmer setting. No Reset thermometer, added water bottles, kept door shut, and checked temps in 1 hour. California Vaccines for Children Program 34.9º 34º 33º 32º 31º 30º 29º 28º & colder Fill out this section if you recorded a MAX that was TOO WARM. Temperatures 1 hour after reset Results How long temps Initials TOO WARM? CURRENT MIN MAX Vaccine not usable, returned to McKesson, recalled patients. Temps stabilized. — — — — NN Temperatures returned to OK range. 42.5 42.5 46.7 30 min. TP VFC Call Center: 1-877-243-8832 www.EZIZ.org IMM-1125 Page 2 (12/14) Fº Refrigerator Temperature Log Four Steps to Protect Your Vaccines Time 16 a.m. 17 a.m. 18 a.m. 19 a.m. 20 a.m. 21 a.m. 22 a.m. 23 a.m. 24 a.m. 25 26 27 28 29 30 31 VFC PIN Step 2 Record the Time and your Initials. Day of Month Refrigerator Location Refrigerator ID Avoid patient recalls by accurately recording temperatures twice a day. Step 1 Month/Year (Days 16-31) Initials Step 3 • Record CURRENT, MIN, and MAX temperatures. Follow steps for one of the three ranges. • Circle if TOO WARM or TOO COLD. Refer to ranges. CURRENT p.m. p.m. p.m. p.m. MIN MAX TOO WARM! 54º & warmer 53º 52º 51º 50º 49º 48º 47º 46.1º p.m. p.m. p.m. p.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m. MAX TOO WARM? 1. Press MEMORY CLEAR/RESET button. 2. Post “Do Not Use Vaccine” sign. 3. Alert your supervisor. 4. A.M. – Call VFC Call Center, or P.M. – Wait 1 hour: • If CURRENT is still TOO WARM, call VFC Call Center. • If CURRENT is OK, no need to call VFC Call Center. 5. Document on Step 4 (next page). OK 46.0º 45º 44º 43º 42º 41º 40º 39º 38º 37º 36º 35.0º TOO COLD! 34.9º 34º 33º 32º 31º 30º 29º 28º & colder CURRENT, MIN, and MAX are all OK. 1. Press MEMORY CLEAR/RESET button. Done. Skip Step 4 (next page). MIN TOO COLD? 1. Press MEMORY CLEAR/RESET button. 2. Post “Do Not Use Vaccine” sign. 3. Alert your supervisor. 4. At any time – Call VFC Call Center. 5. Document on Step 4 (next page). When Log Is Complete Sign and Acknowledge. File and keep log for 3 years. I certify that the temperatures recorded on this log are correct. All temperatures that were TOO WARM or TOO COLD have been circled and corrective action was taken and documented. I understand that falsifying logs will result in vaccines being unusable, patients being revaccinated, and provider possibly replacing vaccines. Staff Names and Initials: On-site Supervisor’s Name & Signature: California Vaccines for Children Program Date: VFC Call Center: 1-877-243-8832 EZIZ.org IMM-1125 Page 3 (12/14) Fº Refrigerator Temperature Log Month/Year (Days 16-31) Refrigerator Location Refrigerator ID VFC PIN Step 4 Document actions for temperatures that are TOO WARM or TOO COLD. TOO WARM Date & Time Incident MIN temp. 31.0, too cold. Example Thermostat set too cold. Temps went up during Example inventory when doors were opened a lot. 54º & warmer 53º 52º 51º 50º 49º 48º 47º 46.1º Called VFC? TOO COLD Corrective Action 34.9º 34º 33º 32º 31º 30º 29º 28º & colder Temperatures 1 hour after reset Results Yes Called VFC and manufacturers, adjusted thermostat to warmer setting. Vaccine not usable, returned to McKesson, recalled patients. Temps stabilized. No Reset thermometer, added water bottles, kept door shut, and checked temps in 1 hour. Temperatures returned to OK range. California Vaccines for Children Program Fill out this section if you recorded a MAX that was TOO WARM. VFC Call Center: 1-877-243-8832 How long temps Initials TOO WARM? CURRENT MIN MAX — — — — NN 42.5 42.5 46.7 30 min. TP www.EZIZ.org IMM-1125 Page 4 (12/14)
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