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Cold chain breach and vaccine wastage form

Cold chain breach and vaccine wastage form

Document temperature excursions, affected vaccines, and corrective actions for proper reporting of vaccine storage incidents.

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Cold chain breach and vaccine wastage form

Document temperature excursions, affected vaccines, and corrective actions for proper reporting of vaccine storage incidents.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

When vaccines are exposed to temperatures outside the recommended +2°C to +8°C range, you need to document the incident properly. This cold chain breach and vaccine wastage form helps you record essential details about compromised vaccines, including exposure duration, affected stock, and required actions.

According to the CDC, cold chain failures result in significant financial losses and potentially ineffective vaccines that may require patient revaccination. With this template, you can quickly isolate affected vaccines, document the breach circumstances, and report to relevant health authorities—ensuring you maintain compliance with healthcare regulations while preserving vaccine integrity and patient safety.

Related categories

  • Quality management templates
  • Pharmaceutical industry templates
  • Quality assurance templates

Created by

Author Name Inioluwa Ademuwagun
Preview of the template
Entity
Incident Details
Date and Time of Incident
Location of Incident
Type of Incident
Cold Chain Breach Details
Duration of Breach (hours)
Suspected Cause of Breach
Was the vaccine exposed to inappropriate temperature?
Was the vaccine exposed to direct sunlight?
Vaccine Wastage Details
Total Vaccine Doses Wasted
Vaccine Type
Reason for Wastage
Mitigation Actions
Actions Taken to Mitigate the Incident
Was the cold chain re-established?
Were the affected vaccines discarded?

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Frequently asked questions

What information should I include when filling out a cold chain breach form?

Record vaccine names, lot numbers, expiry dates, the date and time of the breach, duration of exposure, minimum/maximum temperatures reached, and whether any compromised vaccines were administered to patients. Also document immediate actions taken to isolate affected vaccines and any consultation with manufacturers or health authorities.

How quickly should I report a cold chain breach after discovery?

Report cold chain breaches as soon as possible during business hours. Immediately isolate affected vaccines, label them “DO NOT USE,” and store them at proper temperatures until their viability is determined. If the breach occurs after hours, keep vaccines isolated and report on the next business day.

What should I do with vaccines involved in a cold chain breach?

Immediately separate affected vaccines from your usable stock and label them “DO NOT USE.” Continue storing them at the recommended +2°C to +8°C until their viability is determined. Contact vaccine manufacturers and your local public health unit for guidance on whether vaccines can still be used or must be discarded.

Author
Inioluwa Ademuwagun
Inioluwa is a freelance content writer with a passion for words and everything marketing. She has worked closely with B2B SaaS and e-commerce brands creating product-led content. She loves to read fiction and would describe herself as an introverted nerd who desires to travel around the world. She currently doing that with her words till she can with her eyes
This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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