Routine Vaccine Storage and
Handling Plan Worksheet

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Complete the following checklist and forms and store this information in an easily accessible area near the vaccine storage unit. See the section on Vaccine Storage and Handling Plans for details.

 

Checklist of Resources for the
Routine Vaccine Storage and Handling Plan

 

Up-to-date contact information
 
Primary and backup vaccine coordinators
  State or local health department immunization program
  Manufacturers of the vaccines in your inventory
  Refrigerator and freezer maintenance and repair company(ies)
  Vaccine storage unit alarm company (if applicable)
  Sources for packing materials and certified calibrated thermometers
Descriptions of the roles and responsibilities of the primary and backup
vaccine coordinators
Summaries of the storage requirements for each vaccine and diluent in
your inventory
Protocols for vaccine storage unit temperature monitoring
Protocols for vaccine storage equipment maintenance
Protocols for the correct placement of vaccine(s) within storage units
Protocols for responding to vaccine storage and handling problems
Protocols for vaccine inventory management
Protocols for transporting and receiving vaccine shipments
Policies for preparing vaccine for administration
Protocols for proper disposal of vaccines and supplies
Samples of the forms used in your vaccination program

 

Vaccine Coordinators
Vaccine Coordinators
Title

Telephone Numbers

(home, cell, beeper)

Primary    
Backup    

 

Resources Contact List
Resources

Contact Person

Title

Telephone Numbers

(home, cell, beeper)

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      
Generator Repair Company (if applicable)      
Generator Fuel
Source
(if applicable)
     
Refrigeration Repair Company      
Temperature Alarm
Monitoring Company
(if applicable)
     
Security or Perimeter Alarm Company (if applicable)      
Emergency Resources
Company Name
Contact Person
(title)
Telephone Numbers
(home, cell, beeper)
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