Emergency Vaccine Retrieval and

Storage Plan Worksheet 
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In advance of an emergency, complete the following checklist and forms and store this information in an easily accessible area near the vaccine storage unit. See section on Vaccine Storage and Handling Plans for details.

 

Checklist of Resources for the Emergency

Vaccine Retrieval and Storage Plan

 

Designated primary and backup vaccine coordinators with emergency contact information.
Emergency staff contact list in order of contact preference.
Vaccine storage unit specifications (type, brand, model number, serial number).
Alternate vaccine storage facility or facilities.
Written protocols, vehicles, and drivers for transporting vaccine to and from the alternate vaccine storage facility.
Written instructions for entering your facility and vaccine storage spaces in an emergency if the building is closed or if it is after hours. These instructions should include the building security/after-hours access procedure, a floor diagram and the locations of the following:
 
Doors
 
Flashlights
 
Spare batteries
 
Light switches
 
Keys
 
Locks
 
Alarms (including instructions for use)
 
Circuit breakers
 
Packing materials
Appropriate packing materials to safely transport or temporarily store vaccine.
Prioritized vaccine packing list.
Written protocol for vaccine packing.
Written protocol for appropriately storing vaccine at the alternate storage facility.
Up-to-date list of manufacturer quality control office telephone numbers.

 

Vaccine Coordinators
Vaccine Coordinators
Title

Telephone Numbers

(home, cell, beeper)
Primary    
Backup    

 

Emergency Staff Contact List*
Name
Title

Telephone Numbers

(home, cell, beeper)
1.    
2.    
3.    
4.    
5.    
6.    
* List contacts in order of preference. Determine whether all or certain persons on the list should be contacted or if the first person reached is sufficient. Include the primary and backup vaccine coordinators on the list.

 

Vaccine Storage Unit Specifications
Type of Unit
(Refrigerator or Freezer)
Brand
Model Number
Serial Number
       
       
       
       
       
       
       

 

Emergency Resources Contact List
Emergency Resources

Contact Person

(Title)
Telephone Numbers
(home, cell, beeper)
Additional Staff
(to move and
pack vaccine)		    
   
   
   
State Health
Department
Immunization
Program		    
Local Health
Department
Immunization
Program		    
Emergency Resources
Company Name
Contact Person
(title)
Telephone Numbers
(home, cell, beeper)
Electric Power Company      
Emergency
Generator Repair Company (if applicable)		      
Emergency
Generator Fuel
Source
(if applicable)		      
Refrigeration Repair Company      
Temperature Alarm
Monitoring Company
(if applicable)		      
Security or Perimeter Alarm Company (if applicable)      
Weather Service      
Emergency Resources
Company Name
Contact Person
(title)
Telephone Numbers
(home, cell, beeper)
Alternate Vaccine Storage Facility(s)
Alternate Vaccine
Storage Facility (1)		      
Alternate Vaccine
Storage Facility (2)
(if available)		      
Alternate Vaccine
Storage Facility (3)
(if available)		      
Alternate Vaccine
Storage Facility (4)
(if available)		      
Transportation to Alternate Vaccine Storage Facility(s)*
Refrigeration
Company		      
Refrigeration
Company
(alternate)		      
Private Vehicle
(Not Applicable)
    
Private Vehicle
(alternate)
(Not Applicable)
    
Packing Materials
Insulated Containers or
Coolers		      
Insulated Containers or
Coolers
(alternate)		      
Fillers (e.g., crumpled paper, bubble wrap, Styrofoam™ pellets)      
Fillers
(alternate)		      
Refrigerated/ Frozen
Packs		      
Refrigerated/ Frozen Packs
(alternate)		      
Dry Ice Vendor
(if inventory includes varicella-containing vaccines)		      
Dry Ice Vendor
(alternate)		      
Certified Calibrated
Thermometers		      

Certified Calibrated
Thermometers

(alternate)

      
 
Centers for Disease Control and Prevention