Title Page

  • Site conducted

  • Conducted on

  • 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?

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

  • Date of last revision

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

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

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

  • Were all deviations outside the +2°C to +8°C range reported to the appropriate state or territory health department?

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


Vaccine refrigerator

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

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

  • 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?

  • Date refrigerator was last serviced

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

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

Monitoring equipment

  • Date the temperature sensor(s) was purchased

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

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

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

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

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

Alternative vaccine storage

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

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

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

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

  • Is there enough insulating material for each cooler?


  • Sign-off from person conducting audit

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.