"Vaccines for Children (Vfc) Program Refrigerated Vaccine Transport Log" - New Mexico

Vaccines for Children (Vfc) Program Refrigerated Vaccine Transport Log is a legal document that was released by the New Mexico Department of Health - a government authority operating within New Mexico.

Form Details:

  • Released on February 1, 2020;
  • The latest edition currently provided by the New Mexico Department of Health;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New Mexico Department of Health.

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Download "Vaccines for Children (Vfc) Program Refrigerated Vaccine Transport Log" - New Mexico

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Vaccines for Children (VFC) Program
Refrigerated Vaccine Transport Log
Complete this log when transferring vaccines to an alternate or back-up refrigerator, or when transporting to another provider/location
Data Logger must accompany vaccines
Temperature log must be downloaded and saved when transfer is complete
Transfer Information
FROM Provider Name:
VFC PIN:
Transfer in NMSIIS sent?
Yes
No
n/a*
TO Provider Name:
VFC PIN:
Transfer in NMSIIS rec’d?
Yes
No
n/a*
*only when vaccines are not going to another site
Circle and add notes if necessary
Transfer Reason
Other/ Notes:
Storage unit
Building
Power Outage
Excess Supply
Short-dated
malfunction
maintenance
Vaccine Inventory and Temperature Monitoring Information
Print and attach your on-hand inventory from NMSIIS and the date, time, and initials of the staff member who verified the vaccine count prior
to transport; also, mark any vaccine doses that have been previously transported
Transport Log and Notes: Please include specific dates and times of vaccine packing, transport, unpacking, etc.
Name/s of individuals performing
Serial number of data
Date:
transport tasks below (print):
logger used:
Vaccine counted
Begin time and temp
End time and temp
Initials
Vaccine packed per
guidelines
Begin time and temp
End time and temp
Initials
Vaccine transport
Begin time and temp
End time and temp
Initials
Vaccine unpacked and stored
Begin time and temp
End time and temp
Initials
Total Transport Time: Notes:
If transport temperatures exceed recommended ranges, immediately notify your Regional contact/s at the VFC program:
Metro Region
Northeast Region
Northwest Region
Southeast (a)
Southwest Region
505-383-0153
505-476-2622
505-841-8929 ext. 115
575-746-9819 ext. 6818
575-528-5186
Southeast (b)
505-383-0154
505-476-2643
575-528-5150
575-397-2463 ext. 6516
505-841-5890
Updated Feb. 2020
Vaccines for Children (VFC) Program
Refrigerated Vaccine Transport Log
Complete this log when transferring vaccines to an alternate or back-up refrigerator, or when transporting to another provider/location
Data Logger must accompany vaccines
Temperature log must be downloaded and saved when transfer is complete
Transfer Information
FROM Provider Name:
VFC PIN:
Transfer in NMSIIS sent?
Yes
No
n/a*
TO Provider Name:
VFC PIN:
Transfer in NMSIIS rec’d?
Yes
No
n/a*
*only when vaccines are not going to another site
Circle and add notes if necessary
Transfer Reason
Other/ Notes:
Storage unit
Building
Power Outage
Excess Supply
Short-dated
malfunction
maintenance
Vaccine Inventory and Temperature Monitoring Information
Print and attach your on-hand inventory from NMSIIS and the date, time, and initials of the staff member who verified the vaccine count prior
to transport; also, mark any vaccine doses that have been previously transported
Transport Log and Notes: Please include specific dates and times of vaccine packing, transport, unpacking, etc.
Name/s of individuals performing
Serial number of data
Date:
transport tasks below (print):
logger used:
Vaccine counted
Begin time and temp
End time and temp
Initials
Vaccine packed per
guidelines
Begin time and temp
End time and temp
Initials
Vaccine transport
Begin time and temp
End time and temp
Initials
Vaccine unpacked and stored
Begin time and temp
End time and temp
Initials
Total Transport Time: Notes:
If transport temperatures exceed recommended ranges, immediately notify your Regional contact/s at the VFC program:
Metro Region
Northeast Region
Northwest Region
Southeast (a)
Southwest Region
505-383-0153
505-476-2622
505-841-8929 ext. 115
575-746-9819 ext. 6818
575-528-5186
Southeast (b)
505-383-0154
505-476-2643
575-528-5150
575-397-2463 ext. 6516
505-841-5890
Updated Feb. 2020