Vaccine Storage Packet

Temperature Log for Refrigerator (Fahrenheit)
Completing this temperature log: Check the temperature in the refrigerator compartment of
your vaccine storage unit at least once in the morning and once in the evening each working
day. Place an "X" in the box that corresponds with the temperature and record the ambient
(room) temperature, the time of the temperature readings, and your initials. Once the month
has ended, save each month's completed form for 3 years, unless state or local jurisdictions
require a longer time period.
If the recorded temperature is in the shaded zone: This represents an unacceptable
temperature range.
Day of Month
1
2
3
4
5
6
Month/Year:____________________ Days 1-15
Follow these steps:
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine "do not use" until you have verified whether
or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or
the vaccine manufacturer to determine whether the vaccine is still usable:
(____) __________________________.
4. Document the action taken on the Vaccine Storage Troubleshooting Record.
7
8
9
10
11
12
13
14
15
Staff Initials
Room Temp.
Exact Time
°F Temp
48°
pm am
pm am
pm am
pm am
pm am
pm am
pm am
Temperature adjustment or service may be required*
47°
Refrigerator Temperature
Aim for 40°F
pm am
≥49°
Too warm
Aim for 5°C
am
46°
45°
44°
43°
42°
41°
40°
39°
38°
37°
36°
Too cold
35°
34°
33°
Temperature adjustment or service may be required*
≤32°
*Consult Owner's Manual if temperature persists out of range.
pm am
pm am
pm am
pm am
pm am
pm am
pm
Temperature Log for Refrigerator (Fahrenheit)
Completing this temperature log: Check the temperature in the refrigerator compartment of
your vaccine storage unit at least once in the morning and once in the evening each working
day. Place an "X" in the box that corresponds with the temperature and record the ambient
(room) temperature, the time of the temperature readings, and your initials. Once the month
has ended, save each month's completed form for 3 years, unless state or local jurisdictions
require a longer time period.
If the recorded temperature is in the shaded zone: This represents an unacceptable
temperature range.
Day of Month
16
17
18
19
20
21
Month/Year:____________________ Days 16-31
Follow these steps:
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine "do not use" until you have verified whether
or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or
the vaccine manufacturer to determine whether the vaccine is still usable:
(____) __________________________.
4. Document the action taken on the Vaccine Storage Troubleshooting Record.
22
23
24
25
26
27
28
29
30
31
Staff Initials
Room Temp.
Exact Time
°F Temp
Too warm
48°
Aim for 40°F
pm am
pm am
pm am
pm am
pm am
pm am
pm am
pm am
Temperature adjustment or service may be required*
47°
Refrigerator Temperature
Aim for 5°C
am
≥49°
46°
45°
44°
43°
42°
41°
40°
39°
38°
37°
36°
Too cold
35°
34°
33°
Temperature adjustment or service may be required*
≤32°
*Consult Owner's Manual if temperature persists out of range.
pm am
pm am
pm am
pm am
pm am
pm am
pm am
pm
Temperature Log for Freezer (Fahrenheit)
Completing this temperature log: Check the temperature in the refrigerator
compartment of your vaccine storage unit at least once in the morning and once in the
evening each working day. Place an "X" in the box that corresponds with the
temperature and record the ambient (room) temperature, the time of the temperature
readings, and your initials. Once the month has ended, save each month's completed
form for 3 years, unless state or local jurisdictions require a longer time period.
If the recorded temperature is in the shaded zone: This represents an unacceptable
temperature range.
Day of Month
1
2
3
4
5
6
Month/Year:____________________ Days 1-15
Follow these steps:
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine "do not use" until you have verified whether
or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or
the vaccine manufacturer to determine whether the vaccine is still usable:
(____) __________________________.
4. Document the action taken on the Vaccine Storage Troubleshooting Record.
7
8
9
10
11
12
13
14
15
Staff Initials
Room Temp.
Exact Time
°F Temp
am
pm am
pm am
pm am
pm am
pm am
pm am
pm am
pm am
Too warm
≥8°
7°
Temperature adjustment or service may be required*
6°
Freezer Temperature
5°
4°
3°
2°
1°
0°
-1°
-2°
-3°
-4°
-5°
-6°
-7°
-8°
-9°
≤-10°†
*Consult Owner's Manual if temperature persists out of range.
† Some frozen vaccines must not be stored colder than -58°F. Check the Prescribing Information on
the vaccine manufacturer's website for specific storage temperature instructions.
pm am
pm am
pm am
pm am
pm am
pm am
pm
Temperature Log for Freezer (Fahrenheit)
Completing this temperature log: Check the temperature in the refrigerator
compartment of your vaccine storage unit at least once in the morning and once in the
evening each working day. Place an "X" in the box that corresponds with the
temperature and record the ambient (room) temperature, the time of the temperature
readings, and your initials. Once the month has ended, save each month's completed
form for 3 years, unless state or local jurisdictions require a longer time period.
If the recorded temperature is in the shaded zone: This represents an unacceptable
temperature range.
Day of Month
16
17
18
19
20
21
Month/Year:____________________ Days 16-31
Follow these steps:
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine "do not use" until you have verified whether
or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or
the vaccine manufacturer to determine whether the vaccine is still usable:
(____) __________________________.
4. Document the action taken on the Vaccine Storage Troubleshooting Record.
22
23
24
25
26
27
28
29
30
31
Staff Initials
Room Temp.
Exact Time
°F Temp
am
pm am
pm am
pm am
pm am
pm am
pm am
pm am
pm am
Too warm
≥8°
7°
Temperature adjustment or service may be required*
6°
Freezer Temperature
5°
4°
3°
2°
1°
0°
-1°
-2°
-3°
-4°
-5°
-6°
-7°
-8°
-9°
≤-10°†
*Consult Owner's Manual if temperature persists out of range.
† Some frozen vaccines must not be stored colder than -58°F. Check the Prescribing Information on
the vaccine manufacturer's website for specific storage temperature instructions.
pm am
pm am
pm am
pm am
pm am
pm am
pm am
pm
Vaccine Coordinators
Vaccine Coordinators
Name/Title
Telephone Number
E-mail Address
Primary
Alternate
Resources Contact List
Resources
Contact Person
Telephone Number
E-mail Address
Company Name
Contact Person
Telephone Number
E-mail Address
Local Health Department
Immunization Program
State Health Department
Immunization Program
Additional Resources
Electric Power Company
Generator Repair Company
Refrigerator Repair
Company
Freezer Repair Company
Temperature Alarm
Monitoring Company
Security or Perimeter Alarm
Company
Datalogger Company
Additional Equipment
Companies
Vaccine Storage Troubleshooting Record
Date
Use this page to record the details of the vaccine storage incident, including the date and time of the last known temperature within the appropriate vaccine storage range.
Storage
Room
Time
Unit
Incident
Action Taken
Results
Temp
Temp
Initials

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