Transcription of REFRIGERATOR TEMPERATURE MONITORING LOG: Days 1 …
1 0. 1. 2. 3. 1. 2a. 2. 3. 4. 123456789101112131415ampmampmampmampmamp mampmampmampmampmampmampmampmampmampmamp m DATE F / C1 FIf you have a disability and need this document in a different format, please call 1-800-525-0127 (TDD/TTY 711). DOH 348-077 June 2020 CLINIC NAME:_____ActionStaff InitialsINSTRUCTIONS ON HOW TO RECORD temperatures : Enter Provider Information and circle if you are recording in C or F on the TEMPERATURE log. Write your initials below in Staff Initials, and note the time in Exact Time. Record min/max once each workday (since previous recording), preferably in the morning. Record current temps twice, at beginning and end of each an X in the row that corresponds to the REFRIGERATOR s any out-of-range temp, see instructions to the each month has ended, save each month s log for 3 of MonthMin/Max Temp F C PROVIDER PIN:_____REFRIGERATOR TEMPERATURE MONITORING LOG: Days 1-15 NotesRefrigeratorExact Time of TempPlease list any steps you've taken to address TEMPERATURE or storage unit issues 36 F (2 C) 35 F ( C) 34 F ( C) 33 F ( C) 32 F ( C) 49 F ( C) 48 F ( C) 47 F ( C)Take action if temp is out of range - too warm (above 46 F / 8 C) or too cold (below 36 F / 2 C):Label exposed vaccine do not use, and store it under proper conditions as quickly as possible.
2 Do not discard vaccines unless directed to by the manufacturer(s) and/or your state health the out-of-range temps and the room temp in the Action area on the bottom of the your vaccine coordinator and follow the Vaccine TEMPERATURE excursion Guide. Notify the state of the excursion , viability of the vaccines, and actions taken. For more information, visit: > Storage and HandlingRoom TempFRIDGE NAME/NUMBER:_____MONTH & YEAR:_____ 46 F (8 C) 45 F ( C) 44 F ( C) 43 F ( C) 42 F ( C) 41 F ( C) 40 F ( C) 39 F ( C) 38 F ( C) 37 F ( C)TemperatureRefrigerator Action Taken: Fridge control adjusted, notified DOH for0. 1. 2. 3. 1. 2a. 2. 3. 4. 16171819202122232425262728293031ampmampm ampmampmampmampmampmampmampmampmampmampm ampmampmampmampm DATE F / C1 FPlease list any steps you've taken to address TEMPERATURE or storage unit issuesAction Taken: Fridge control adjusted, notified DOH you have a disability and need this document in a different format, please call 1-800-525-0127 (TDD/TTY 711).
3 DOH 348-077 June 2020 REFRIGERATOR TEMPERATURE MONITORING LOG: Days 16-31 FRIDGE NAME/NUMBER:_____CLINIC NAME:_____INSTRUCTIONS ON HOW TO RECORD temperatures :Circle if you are recording in C or F on the TEMPERATURE log. Write your initials below in Staff Initials, and note the time in Exact Time. Record min/max once each workday (since previous recording), preferably in the morning. Record current temps twice, at beginning and end of each an X in the row that corresponds to the REFRIGERATOR s any out-of-range temp, see instructions to the each month has ended, save each month s log for 3 action if temp is out of range - too warm (above 46 F / 8 C) or too cold (below 36 F / 2 C):Label exposed vaccine do not use, and store it under proper conditions as quickly as possible. Do not discard vaccines unless directed to by the manufacturer(s) and/or your state health the out-of-range temps and the room temp in the Action area on the bottom of the your vaccine coordinator and follow the Vaccine TEMPERATURE excursion the state of the excursion , viability of the vaccines, and actions of MonthMin/Max Temp RefrigeratorExact Time of TempRoom TempStaff InitialsAction 45 F ( C) 44 F ( C) 43 F ( C) 42 F ( C)TemperatureRefrigerator 36 F (2 C) 35 F ( C) 34 F ( C) 33 F ( C) 32 F ( C) 41 F ( C) 40 F ( C) 39 F ( C) 38 F ( C)F C PROVIDER PIN:_____MONTH & YEAR:_____ 37 F ( C) 49 F ( C) 48 F ( C) 47 F ( C) 46 F (8 C)AIM for0.
4 1. 2. 3. 1. 2a. 2. 3. 4. 123456789101112131415ampmampmampmampmamp mampmampmampmampmampmampmampmampmampmamp m DATE F / C1 FIf you have a disability and need this document in a different format, please call 1-800-525-0127 (TDD/TTY 711). DOH 348-077 June 2020 FREEZER TEMPERATURE MONITORING LOG: Days 1-15 NotesDay of MonthMin/Max Temp FreezerExact Time of TempRoom TempStaff InitialsINSTRUCTIONS ON HOW TO RECORD temperatures :Circle if you are recording in C or F on the TEMPERATURE log. Write your initials below in Staff Initials, and note the time in Exact Time. Record min/max once each workday (since previous recording), preferably in the morning. Record current temps twice, at beginning and end of each an X in the row that corresponds to the freezer s any out-of-range temp, see instructions to the each month has ended, save each month s log for 3 action if temp is out of range - too warm (above 6 F / C) or too cold (below -57 F / -50 C):Label exposed vaccine do not use, and store it under proper conditions as quickly as possible.
5 Do not discard vaccines unless directed to by the manufacturer(s) and/or your state health the out-of-range temps and the room temp in the Action area on the bottom of the your vaccine coordinator and follow the Vaccine TEMPERATURE excursion the state of the excursion , viability of the vaccines, and actions NAME/NUMBER:_____CLINIC NAME:_____PROVIDER PIN:_____MONTH & YEAR:_____ActionPlease list any steps you've taken to address TEMPERATURE or storage unit issues 2 F ( C) -5 F ( C) -6 F ( C) -7 F to -57 F -58 F (-50 C) 1 F ( C) 0 F ( C) -1 F ( C) -2 F ( C) -3 F ( C) 3 F ( C) C 8 F ( C) -4 F ( C) 7 F ( C) 6 F ( C) 5 F ( C) 4 F ( C) Action Taken: Fridge control adjusted, notified DOH TemperatureF 0. 1. 2. 3. 1. 2a. 2. 3. 4.
6 16171819202122232425262728293031ampmampm ampmampmampmampmampmampmampmampmampmampm ampmampmampmampm DATE F / C1 FNotesDay of MonthMin/Max Temp FreezerExact Time of TempRoom TempStaff InitialsFREEZER TEMPERATURE MONITORING LOG: Days 16-31 FREEZER NAME/NUMBER:_____CLINIC NAME:_____INSTRUCTIONS ON HOW TO RECORD temperatures :Circle if you are recording in C or F on the TEMPERATURE log. Write your initials below in Staff Initials, and note the time in Exact Time. Record min/max once each workday (since previous recording), preferably in the morning. Record current temps twice, at beginning and end of each an X in the row that corresponds to the freezer s any out-of-range temp, see instructions to the each month has ended, save each month s log for 3 action if temp is out of range - too warm (above 6 F / C) or too cold (below -57 F / -50 C):Label exposed vaccine do not use, and store it under proper conditions as quickly as possible.
7 Do not discard vaccines unless directed to by the manufacturer(s) and/or your state health the out-of-range temps and the room temp in the Action area on the bottom of the your vaccine coordinator and follow the Vaccine TEMPERATURE excursion the state of the excursion , viability of the vaccines, and actions more information, visit: > Storage and HandlingMONTH & YEAR:_____F C PROVIDER PIN:_____If you have a disability and need this document in a different format, please call 1-800-525-0127 (TDD/TTY 711). DOH 348-077 June 2020 ActionPlease list any steps you've taken to address TEMPERATURE or storage unit issuesFreezer TEMPERATURE -7 F to -57 F -3 F ( C) -58 F (-50 C) -2 F ( C) -4 F ( C) -5 F ( C) -6 F ( C) 2 F ( C) 1 F ( C) 0 F ( C) -1 F ( C) 3 F ( C) Action Taken: Fridge control adjusted, notified DOH etc. 8 F ( C) 7 F ( C) 6 F ( C) 5 F ( C) 4 F ( C)
