Transcription of Vaccine Refrigerator Temperature Record
1 Vaccine Storage Unit Temperature Record20706 (Rev2022-06) SiteMonthVaccine Storage UnitYearDateTimeCurrent TempMaximum TempMinimum TempInitial TimeCurrent TempMaximum TempMinimum TempInitial12345678910111213141516171819 20 Page 1 of 3 Vaccine Storage Unit Temperature Record20706 (Rev2022-06) SiteMonthVaccine Storage UnitYearDateTimeCurrent TempMaximum TempMinimum TempInitial TimeCurrent TempMaximum TempMinimum TempInitial2122232425262728293031 Weekly AuditDateInitialsInitials and Printed Name of RecorderInitialsPrinted NameInitialsPrinted NamePage 2 of 3 NotesVaccine Storage Unit Temperature Record20706 (Rev2022-06) a new form for each new in the site and Vaccine storage unit serial number (or other identifying information, Fridge #1,Freezer #1, etc.)
2 Along with the current month and year that the data is being the Current Temp., Maximum Temp., Minimum Temp. readings from the Temperature minimum, Record temperatures in C twice a day (separated by at least 8 hours). Temperature can berecorded up to 4 times a using a minimum/maximum thermometer, clear/reset the memory after every Temperature reading andrecording. For other Temperature monitoring devices, refer to instruction manual for how to your initials as the recorder of the Temperature reading. Initial and print name on reverse Temperature outside of recommended Vaccine storage Temperature , report cold chain excursion as perAlberta Health Services (AHS) Vaccine Storage and Handling there are any Temperature excursions that do not result in the submission of a cold chain excursionreport, an explanation should be documented on the Temperature log after discussion with your AHSZone Contact ( the door was open while adding Vaccine inventory Temperature out of range for 10minutes).
3 Record is to be reviewed weekly to ensure proper Temperature recording and take appropri-ate action if discrepancies. Date and initial when weekly audit is monitoring logs must be kept for 5 more information, go to and see Alberta Health Services Vaccine Storage and Handling Standard and Alberta Health Vaccine Storage and Handling for COVID-19 VaccinePage 3 of 3
