Vaccine Fridge

• Site conducted

  Select

• Conducted on

  Date

• Facility and Department

• Prepared by

Procedures

• Have all staff received orientation and/or an annual update on vaccine management?

  Yes

  No

  N/A

• Has the vaccine management policy been reviewed as required and is up to date?

  Yes

  No

  N/A

• Is graph/logbook/chart for temperature recording readily available?

  Yes

  No

  N/A

• Is the temperature of the vaccine refridgerator recorded twice a day when the facility is open?

  Yes

  No

  N/A

• Are the contact numbers to report a cold chain breach easily accessible

  Yes

  No

  N/A

• Were all deviations outside the +2°C to +8°C range reported to pharmacy and IC manager

  Yes

  No

  N/A

• Have the responses to all deviations outside the +2°C to +8°C range been documented and recommended actions taken?

  Yes

  No

  N/A

Equipment

• Has the refrigerator shown evidence of malfunction (eg poor seals so that the door opens too easily)?

  Yes

  No

  N/A

• Has corrective action been taken?

  Yes

  No

  N/A

• Is there an appropriate gap between the vaccines and the walls of the refrigerator?

  Yes

  No

  N/A

• Can the refrigerator continue to store the required volume of vaccines safely according to these guidelines? (This includes times of increased demand such as the influenza program.)

  Yes

  No

  N/A

• Does the power outlet have a sign ‘Do not turn off or disconnect this refrigerator’?

  Yes

  No

  N/A

• Is the refrigerator plugged into a red OR blue power point?

  Yes

  No

  N/A

Monitoring equipment

• Has the refrigerator been serviced in the past 6 months?

  Yes

  No

  N/A

• Date and results of last Thermometer accuracy check:

Alternative vaccine storage

• Is there a readily accessible written procedure for what to do during a power failure?

  Yes

  No

  N/A

• Is enough alternative storage (eg cooler, other monitored refrigerator) available for vaccine storage, if necessary (eg vaccine refrigerator breakdown or power failure)?

  Yes

  No

  N/A

• Are ice packs/gel packs at the correct temperature available?

  Yes

  No

  N/A

• Is there one minimum/maximum thermometer for each cooler?

  Yes

  No

  N/A

• Is there enough insulating material for each cooler?

  Yes

  No

  N/A

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