Vaccine storage self-audit

• Site conducted

  Select

• Conducted on

  Date

• Person conducting audit

• Nominated person responsible for vaccine management

• Nominated back-up person responsible for vaccine management

Refrigerator being audited

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

  Yes

  No

  N/A

• Have vaccine management policies been reviewed in the past 12 months to ensure that procedures are up to date?

  Yes

  No

  N/A

• Date of last revision

  Date

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

  Yes

  No

  N/A

• Is the temperature of the vaccine refrigerator 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 the appropriate state or territory health department?

  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

Vaccine refrigerator

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

  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.) If ‘No’, what action is being taken?

  Yes

  No

  N/A

• Date refrigerator was last serviced

  Date

• If the refrigerator has a solid door, is a map or guide to where vaccines are stored located on the outside of the door?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Monitoring equipment

• Date the temperature sensor(s) was purchased

  Date

• Date the battery for the minimum/maximum thermometers was last changed?

  Date

• Date and results of thermometer accuracy check at 0°C

  Date

• Is the thermometer temperature sensor(s) placed correctly?

  Yes

  No

  N/A

• Date the battery of the temperature sensor(s) was last changed

  Date

• Date the temperature sensor(s) was last serviced or calibrated

  Date

• 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

• Sign-off from person conducting audit

  Sign