Maintain this log for a minimum of two years or until given permission to discard it. Put a do not use vaccines sign on the refrigerator. After each month has ended, save each months log for 5 years. Edit, fill, sign, download temperature log for refrigerator online on. Clear minmax temperature daily after recording the temperatures on the temperature log. A designated food service employee will record the time, air temperature and their initials. Start a free trial now to save yourself time and money. Document what corrective action was taken if the food is found above 41f. Designated staffvolunteers will record the time, air temperature and their initials. North carolina immunization program refrigerator vaccines. This log will be maintained for each refrigerator and freezer both walkin and reachin units in des ignated staffvolunteers will rec ord the time, air temperature and the r initials. A designated food service employee will record the time, air temperature and their initials preferably upon arrival once in the. Complete the top of the form with the monthyear, refrigerator idlocation, vfc pin, and name of clinic.
Refrigerator monthyear day of month time staff initials min max 36 37 38 39 40 41 42 43 44 45 46 when temps are out of range 1 2 3 4 5 6 7 8 9 10 11 full temp. If temperature of phf is above 4c40f, take immediate corrective action and record in log. If any out of range temps, see instructions to the right. Record the minmax temps once each workdaypreferably in the morning 5. Write min and max temperatures above and notify the nyc vfc program of any unacceptable temperatures immediately. Check the temperatures in both the freezer and the refrigerator. Temperature log for refrigerator and freezer pennsylvania. Maintain this l g mum of two years or until given perm iss on to discard it.
Temperature log for refrigerator fahrenheit page 2 of 3 days 16 31 monitor temperatures closely. Compare your refrigerator thermometer with your calibrated stemtype thermometer monthly to ensure it is accurate. Temperature log for refrigerator edit, fill, sign online. South carolina freezer temperature log celsius for vaccine storage units dhec 3265 pdf south carolina refrigerator temperature log celsius for vaccine storage units dhec 3266 pdf temperature monitoring devices state purchased ddl devices. Freezer temperature range should be 50oc to 15oc or 58of to 5of. Label exposed vaccine do not use, and store it under proper conditions as quickly as possible.
Doh 348077 august 2018 refrigerator temperature monitoring log. The way to complete the online refrigerator temperature log on the internet. Notify your public health authority of any planned travel during this time period. Temperature log for refrigerator fahrenheit temperature log for refrigerator fahrenheit, recording fahrenheit temperatures in refrigerator for vaccines, vaccine temperature log for refrigerator in fahrenheit, vaccine storage troubleshooting record, examples of completed vaccine troubleshooting record for refrigerated vaccines in fahrenheit. Refrigerator temperature log southern nevada health. Tennessee immunization program tip temperature log for. Record the minmax temps once each workday preferably in the morning. If temperature of phf is 7 c45f or above discard all phfs and repair cooler.
F temperature log for refrigerator fahrenheit page 1 of 3. Temperature log for refrigerator and freezer fahrenheit. Record the outofrange temps and the room temp in the action area as labeled on the temperature log. Record the out of range temp and the room temp in the action 6. Our free newsletter includes monthly disease updates. Place an x or record the temperature in the box that corresponds with the temperature range. Daily freezer refrigerator temperature log instructions. Thanks, your survey has been submitted to the mass. Fill out, securely sign, print or email your temperature log for refrigerator form instantly with signnow.
Record the minmax temps once each workdaypreferably in the morning. South carolina refrigerator temperature log celsius for vaccine storage units dhec 3266 pdf south carolina vaccine programs disenrollment form vfc or sc state dhec 1984 pdf vaccines for children vfc program suspected fraud andor abuse referral sheet form dhec 1997 pdf for private providers only. Record minmax temperatures daily at opening of the clinic in fahrenheit. Apr 22, 2014 apr 22, 2014 temperature chart template refrigerator temperature log form stay safe and healthy. Time o 25 a o 19 o ampm record exact temperatures twice daily, including minmax once daily. Food safety temperature logs, temperatures and thermometers. Notify the clinic vaccine coordinator and call the iowa immunization program at 18008316293. Take action if temp is out of range too warm above 8. You can also check out our collection of blood sugar log templates temperature logging sounds a little bit different than normal, but this task is important these days. F temperature log for freezer fahrenheit page 1 of 3 days 1. Remember not to store any potentially hazardous foods in the door of this refrigerator e.
Please contact the vaccine manufacturer if your temperatures are. Take action if temp is out of range too warm above 5. Take action if temp is out of rangetoo warm above 8. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds.
F temperature recording form for refrigerator month year. Record temperatures once per day when using a digital data logger thermometer. After each month has ended, save each months log for 3 years, unless statelocal jurisdictions require a longer period. Write your initials below in staff initials, and note the time in exact time. Refrigerator temperature log pdf fahrenheit refrigerator and freezer temperature logs freezer temperature log pdf refrigerator temperature log pdf temperature excursion incident report pdf temperature conversion chart pdf vaccine documentation and policy information. Fill out, securely sign, print or email your vaccine refrigerator temperature log mass instantly with signnow. Do not discard vaccines unless directed to by the immunization division. Celsius refrigerator temperature log celsius freezer temperature log transporting vaccines 6i transporting frozen vaccines transporting refrigerated vaccines vaccine transport inventory sheet and monitoring sheet best practices and resources 6j nist certified data logger manufacturers pa. Please contact the vaccine manufacturer if your temperatures are outside of. This log will be maintained for each refrigerator and freezer both walkin and reachin units in the facility.
If cooler thermometer reads higher than 4c40f, take temperature of a phf in the cooler with metal stem thermometer. Take action if temp is out of rangetoo warm above 15. Fahrenheit refrigerator temperature log for vaccines dhss. Take action if temp is out of rangetoo warm above 4 6. The min and max temperatures recorded on the next day the unit is opened will capture the range of temperatures. Enter your official identification and contact details.
Temp initial temp initial temp initial temp initial temp initial temp initial 1 2 3 4 5 6 7 8 9 10 11 12 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31. The advanced tools of the editor will direct you through the editable pdf template. Download data logger data regularly and save to computer file. After each month has ended, save months log for 5 years. Freezer temperature log pdf refrigerator temperature log pdf temperature excursion incident report pdf temperature conversion chart pdf vaccine documentation and policy information. Refrigerator temperature log free pdf file sharing. Keep all vfc temperature logs and data files for three years. Today the temperature logging is important in many aspects of life. Put an x in the row that corresponds to the refrigerators temperature. There is no substitute for manually checking documenting the temperature twiceaday document the date, time, and temperature on a vaccine log pay special attention to any trend in deviation of temperature. Write staff initials in staff initials, and note the time in exact time. If the temperature is too warm or too cold, follow the actions steps listed on reverse side.
California vaccines for children program imm1125 page 1 1215 take action for one of the three ranges. Southern nevada health district, environmental health division p. If any outofrange temp, see instructions to the right. Month year fax all temperature logs since previous order, along with vaccine order and usage form to 6179836924. Temperature logging sounds a little bit different than normal, but this task is important these days. Maintain this log for a minimum of three yeaand until givenrs permission to discard it.
Store vaccine on hand according to the most recent ncip minimum required vaccine ordering, handling and. If you would like to continue helping us improve mass. Vaccine contraindications pdf nyc vfc program provider satisfaction survey pdf. Temperature log for refrigerator celsius page 2 of 3 days 1631 monitor temperatures closely. If corrective action is required on any day, circle the date in the first column and explain the action taken on the. Refrigerator freezer temperature log record temperatures twice 2x a day. Temperature log for refrigerator fahrenheit page 1 of 3 days 1 15 monitor temperatures closely. Keys to storing and handling your vaccine supply apr 2018 a video designed to decrease vaccine storage and handling errors and preserve the nations vaccine supply by demonstrating to immunization providers the recommended best practices for storage and handling of vaccines. A a designated food service employee will record the time, air temperature and their initials preferably upon arrival once in the. Put an x in the row that corresponds to the refrigerator s temperature. Ifany outofrange temp,see instructions tothe right. Refrigerator vaccines temperature storage log required to be maintained for 3 years post on or near the vaccine storage unit and use to record required readings of am and pm temperatures for vaccines ncip temperature log.
Form 670f to viewprint pdf documentation you will need adobe reader. Maine immunization program refrigerator temperature log. This log will be maintained for each refrigerator and freezer both walkin and. Daily refrigerator freezer storage room temperature log. Temperature log for refrigerator fahrenheit immunization. This log will be maintained for each refrigerator and freezer both walkin a nd reachin units in the facility. Download these 11 free sample temperature log templates to help you log your temperature effectively. Temperature log sheets word temperature log sheets with food temperatures word cold holding. Printable and fillable temperature log for refrigerator. Take action if temp is out of rangetoo warm above 5.
Please practice handwashing and social distancing, and check out our resources for adapting to these times. Temperature chart template refrigerator temperature log. Check thermometer of all coolers and freezers at least twiceday and record temperature in log. Logs are fillable tools used to monitor and verify food safety practices. Wait 15 minutes and recheck the temperature of the freezer. Refrigeratorfreezer temperature log medical mutual insurance.
Document the action taken on the emergency response worksheet and troubleshooting record. Vfc 400 vaccine monitoring digital data logger powerpoint instructional guides. Record the outofrange temperatures and the room temperature in the action area on the bottom of the log. Take a ction i f temp is out of r angetoo warm above 46. Fahrenheit refrigerator temperature log for vaccines. Record the minmax temps once each workdaypreferably in. The johns hopkins medical institutions document poc3801. F temperature log for refrigerator fahrenheit page 1 of. Acceptable temperatures for the refrigerator must fall between. You can also check out our collection of blood sugar log templates. Potentially hazardous foods phfs must be stored at a temperature of 4c40f or below at all times. If the temperature is above 41f, notify the person in charge pic immediately. Refrigeratorfreezer temperature log medical mutual. Refrigerator temperature log fill out and sign printable.
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