Contingency Plan For Vaccine Storage PDF Details

Every year, the United States celebrates National Vaccine Awareness Day on April 12th. This day is dedicated to raising awareness about vaccines and their importance for health. Experts recommend that all children get vaccinated against 13 diseases including polio, measles, mumps, rubella, tetanus and chickenpox. A contingency plan for vaccine storage is essential to ensure that vaccines are stored at the correct temperature so they can be effective in case of an emergency. This blog post will explore some ways you can create a contingency plan for vaccine storage in your home or workplace environment.

The table provides information regarding the contingency plan for vaccine storage. Prior to complete the form, it can be worth learning a little more about it.

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

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

Watch Contingency Plan For Vaccine Storage Video Instruction

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