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B. Vaccine and Cold Chain Checklist
Observe vaccine storage units to confirm the following practices:
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1.
Name of Contractor Completing Survey:
(Required.)
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2.
List what vaccines are currently available at the facility. Verify this visually.
(Required.)
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3.
All vaccines stored at the facility are within their expiration window. Verify this visually.
(Required.)
True
False
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4.
The refrigerator/freezer unit used is appropriate for vaccine storage (e.g., not dorm-style) (attach photos separately).
(Required.)
True
False
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5.
Vaccines are stored properly within the refrigerator (e.g., not in door, top shelf, floor, or produce drawers, positioned 2-3 in from the walls) (attach photos separately).
(Required.)
True
False
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6.
Vaccines are stored in an organized manner and in their original packaging.
(Required.)
True
False
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7.
Food, drinks, or other medications are kept separate from vaccines.
(Required.)
True
False
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8.
An adequate temperature monitoring device (e.g., buffered digital data logger or at least a device that alarms when out of temperature range) is used (attach photos).
(Required.)
True
False
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9.
Temperature logs are maintained with once daily recording (at clinic opening).
(Required.)
True
False
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10.
Temperature monitoring device logs maximum and minimum temperatures or twice a day (at clinic opening and closing).
(Required.)
True
False
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11.
There is a procedure for monitoring temperatures over weekends/holidays.
(Required.)
True
False
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12.
Review available temperature logs for the last 3 months. Refrigerator temperatures are consistently between 2–8°C.
(Required.)
True
False
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13.
Facility can describe what actions are taken if out-of-range temperature values are identified.
(Required.)
True
False
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14.
Facility has a backup generator.
(Required.)
True
False
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15.
Clinic staff can describe the Vaccine TI blanket waivers.
(Required.)
True
False
If not, what questions need to be addressed?
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16.
Clinic staff understand that the “not routinely available” blanket waiver means not available in the country and just not at their clinic.
(Required.)
True
False
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17.
Facility has reviewed this cold chain toolkit
https://www.cdc.gov/vaccines/hcp/downloads/storage-handling-toolkit.pdf
(Required.)
True
False
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18.
Additional comments about vaccine practices: (open comment)
(Required.)