Contingency Plan For Vaccine Storage PDF Details

In the realm of healthcare and vaccine distribution, the integrity of vaccine storage is of paramount importance, necessitating detailed planning and coordination to mitigate any potential risks that might compromise vaccine efficacy. The Contingency Plan For Vaccine Storage form, a crucial document devised for such purposes, provides a structured approach for facilities to prepare for unexpected events affecting vaccine storage. This comprehensive form captures every vital piece of information, starting from the facility's name, its TVFC PIN, address, and contact details, leading up to the meticulous planning regarding the transfer of vaccines in case of emergencies. It outlines responsibilities, assigning specific clinic staff for the transfer and designating backup personnel, thereby ensuring continuity and readiness. Moreover, it includes details on alternative facilities for vaccine transfer, complete with contact information and addresses, while also specifying whether generators are available for maintaining optimal storage temperatures. The form further guides on acquiring necessary supplies like ice, dry ice, and coolers, and details concerning shipping agents for transporting vaccines. It lays out checklists for transportation of both refrigerated and frozen vaccines, highlighting the importance of temperature monitoring, proper inventory documentation, and labeling to safeguard the vaccines' integrity during transit. Additionally, the document underscores the necessity of coordination with Local Health Departments (LHD) or Health Service Regions (HSR) in planning and executing vaccine transfers, ensuring a cohesive action plan is in place during city-wide emergencies. This meticulous and forward-thinking approach embodied in the Contingency Plan For Vaccine Storage form underscores the healthcare sector's commitment to public health safety and its resilience in facing unforeseen challenges.

QuestionAnswer
Form NameContingency Plan For Vaccine Storage
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesvaccine storage contingency plan form, Immunization, C-33, contingency plan for vaccine storage

Form Preview Example

Vaccine Storage Contingency Plan

Facility Name: _____________________________________________

 

TVFC PIN: _______________

Address: _________________________________________________

 

Date: ___________________

City, State, Zip Code: _________________________________________

 

Phone: __________________

 

 

 

 

Clinic staff responsible for transfer of vaccine:

 

Phone number:

 

Name:

(

)

 

 

 

 

 

Name (back-up):

(

)

 

 

 

 

Transfer vaccine to:

 

Phone number:

 

Facility Name:

(

)

 

 

 

 

 

 

Address:

 

Generator: Yes No

 

 

 

 

Contact Name:

Date of agreement:

 

 

 

 

Where to obtain:

 

Phone number:

 

Ice:

(

)

 

 

 

 

 

Dry ice:

(

)

 

 

 

 

 

Cooler:

(

)

 

 

 

 

Shipping Agent:

 

Phone number:

 

Tracking number:

(

)

 

 

 

 

 

Contact with LHD/HSR made prior to transport by:

 

 

 

Transport of refrigerated vaccine checklist:

 

 

 

 

Temperature of refrigerator prior to transport:

 

 

 

 

 

 

Inventory of vaccine (use C-33) and included in bag with vaccine. Keep a copy for your records.

 

 

 

 

 

 

Bag labeled with PIN, clinic name, clinic contact, phone number.

 

 

 

 

 

 

 

 

 

Container used to transport refrigerated vaccine:

 

 

 

 

 

 

 

 

 

Ice packs are in container separated from vaccine by crumpled paper.

 

 

 

 

 

 

 

 

 

Thermometer in container.

 

 

 

 

 

 

 

 

 

Time and temperature in container prior to transport:

 

 

 

 

 

 

 

 

 

Person transporting vaccine:

 

 

 

 

 

 

 

 

Transport of frozen vaccine checklist:

 

 

 

 

Temperature of freezer prior to transport:

 

 

 

 

 

 

Inventory of vaccine (use C-33) and included in bag with vaccine. Keep a copy for your records.

 

 

 

 

 

 

Bag labeled with PIN, clinic name, clinic contact, phone number.

 

 

 

 

 

 

 

 

 

Container used to transport vaccine:

 

 

 

 

 

 

 

 

 

Varicella packed in dry ice.

 

 

 

 

 

 

 

 

 

Thermometer in container.

 

 

 

 

 

 

 

 

 

Time and temperature in container prior to transport:

 

 

 

 

 

 

 

 

In the event of a city-wide evacuation, contact your health service region for evacuation plan. HSR Contact Name: ___________________________Phone number: (_____)_____________

Texas Department of State Health Services

Stock No. 11-11190

Immunization Branch

Rev. 07/2007

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Step 1: The first step will be to pick the orange "Get Form Now" button.

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completing Varicella part 1

Enter the appropriate details in the field Shipping Agent, Tracking number, Phone number, Contact with LHDHSR made prior to, Temperature of refrigerator prior, Inventory of vaccine use C and, Bag labeled with PIN clinic name, Container used to transport, Ice packs are in container, Thermometer in container, Time and temperature in container, Person transporting vaccine, Transport of frozen vaccine, Temperature of freezer prior to, and Inventory of vaccine use C and.

step 2 to filling out Varicella

You'll be demanded particular valuable information if you need to fill out the Bag labeled with PIN clinic name, Container used to transport vaccine, Varicella packed in dry ice, Thermometer in container, Time and temperature in container, In the event of a citywide, HSR Contact Name Phone number, Texas Department of State Health, and Stock No Rev field.

Finishing Varicella step 3

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