"Min/Max Temperature Log for Refrigerator and Freezer - Northeast Region" - New Mexico

Min/Max Temperature Log for Refrigerator and Freezer - Northeast Region 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 June 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 "Min/Max Temperature Log for Refrigerator and Freezer - Northeast Region" - New Mexico

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Month
/
Year_________________________ VFC PIN #____________ Phone # ____________________
Min/Max Temperature Log for
Refrigerator and Freezer (F°)
Site Name ____________________________________ Refrigerator ____ Freezer____ Unit name _____________
Days 1-15
NORTHEAST REGION
Monitor temperatures a minimum of TWICE A DAY
Record the room temperature each morning
Take action if temperatures are out of range!
A.M. Reading:
Record Staff Initials in the first box
If you have an out-of-range temp, immediately contact your Regional staff and complete a
Record the min/max temps in Min/max boxes below yellow bar
Troubleshooting Record (TSR) following the instructions on the TSR form:
Record the actual temperature from the data logger display in the am column
below the blue bar by marking the temperature with an “X”
Dawn Aldridge, RN, 505-476-2622
dawn.aldridge@state.nm.us
, Scarlett Swanson, 505-476-
P.M. Reading:
Record Staff Initials in the second box
2643 scarlettc.swanson@state.nm.us, or Stephanie Salazar
stephaniea.salazar@state.nm.us
Record the actual temperature from the data logger display in the pm column
DO NOT USE VACCINES UNTIL INSTRUCTED TO DO SO BY VFC STAFF
below the blue bar by marking the temperature with an “X”
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Day of Month
Room Temp
Staff Initials
Exact time am
Exact time pm
Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max
Min max Temps
a.m.
Danger! Refrigerator temperatures above 46°F are too warm! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
Actual temp am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
46ᵒ
45ᵒ
44ᵒ
43ᵒ
42ᵒ
41ᵒ
40ᵒ
39ᵒ
38ᵒ
37ᵒ
36ᵒ
Danger! Refrigerator temperatures below 36°F are too cold! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max
Min max Temps
a.m.
Danger! Freezer temperatures above 6°F are too warm! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
Actual temp am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
5ᵒ
4ᵒ
≤ 3ᵒ
Page 1 of 2
Updated June 2020
THIS DOCUMENT MUST BE RETAINED IN YOUR FILES FOR THREE (3) YEARS
Month
/
Year_________________________ VFC PIN #____________ Phone # ____________________
Min/Max Temperature Log for
Refrigerator and Freezer (F°)
Site Name ____________________________________ Refrigerator ____ Freezer____ Unit name _____________
Days 1-15
NORTHEAST REGION
Monitor temperatures a minimum of TWICE A DAY
Record the room temperature each morning
Take action if temperatures are out of range!
A.M. Reading:
Record Staff Initials in the first box
If you have an out-of-range temp, immediately contact your Regional staff and complete a
Record the min/max temps in Min/max boxes below yellow bar
Troubleshooting Record (TSR) following the instructions on the TSR form:
Record the actual temperature from the data logger display in the am column
below the blue bar by marking the temperature with an “X”
Dawn Aldridge, RN, 505-476-2622
dawn.aldridge@state.nm.us
, Scarlett Swanson, 505-476-
P.M. Reading:
Record Staff Initials in the second box
2643 scarlettc.swanson@state.nm.us, or Stephanie Salazar
stephaniea.salazar@state.nm.us
Record the actual temperature from the data logger display in the pm column
DO NOT USE VACCINES UNTIL INSTRUCTED TO DO SO BY VFC STAFF
below the blue bar by marking the temperature with an “X”
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Day of Month
Room Temp
Staff Initials
Exact time am
Exact time pm
Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max
Min max Temps
a.m.
Danger! Refrigerator temperatures above 46°F are too warm! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
Actual temp am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
46ᵒ
45ᵒ
44ᵒ
43ᵒ
42ᵒ
41ᵒ
40ᵒ
39ᵒ
38ᵒ
37ᵒ
36ᵒ
Danger! Refrigerator temperatures below 36°F are too cold! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max
Min max Temps
a.m.
Danger! Freezer temperatures above 6°F are too warm! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
Actual temp am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
am
pm
5ᵒ
4ᵒ
≤ 3ᵒ
Page 1 of 2
Updated June 2020
THIS DOCUMENT MUST BE RETAINED IN YOUR FILES FOR THREE (3) YEARS
Month
Year _________________________ VFC PIN #___________ Phone # ____________________
/
Min/Max Temperature Log for
Refrigerator and Freezer (F°)
Site Name _________________________________ Refrigerator____ Freezer___ Unit name ______________
Days 16 – 31
NORTHEAST REGION
Monitor temperatures a minimum of TWICE A DAY
Record the room temperature each morning
_
Take action if temperatures are out of range!
A.M. Reading:
Record Staff Initials in the first box
If you have an out-of-range temp, immediately contact your Regional staff and complete a
Record the min/max temps in Min/max boxes below yellow bar
Troubleshooting Record (TSR) following the instructions on the TSR form:
Record the actual temperature from the data logger display in the am column
below the blue bar by marking the temperature with an “X”
1.
Dawn Aldridge, RN, 505-476-2622
dawn.aldridge@state.nm.us
, Scarlett Swanson, 505-476-
P.M. Reading:
Record Staff Initials in the second box
2643 scarlettc.swanson@state.nm.us, or Stephanie Salazar
stephaniea.salazar@state.nm.us
Record the actual temperature from the data logger display in the pm column
DO NOT USE VACCINES UNTIL INSTRUCTED TO DO SO BY VFC STAFF
below the blue bar by marking the temperature with an “X”
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day of Month
Room Temp
Staff Initials
Exact time am
Exact time pm
Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max
Min max Temps
a.m.
Danger! Refrigerator temperatures above 46°F are too warm! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
am pm
Actual temp am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm
46ᵒ
45ᵒ
44ᵒ
43ᵒ
42ᵒ
41ᵒ
40ᵒ
39ᵒ
38ᵒ
37ᵒ
36ᵒ
Danger! Refrigerator temperatures below 36°F are too cold! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max
Min max Temps
a.m.
Danger! Freezer temperatures above 6°F are too warm! Record any out-of-range temps and room temps and call your Immunization Coordinator immediately!
Actual temp am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm am pm
am pm
5ᵒ
4ᵒ
≤ 3ᵒ
Page 2 of 2
Updated June 2020
THIS DOCUMENT MUST BE RETAINED IN YOUR FILES FOR THREE (3) YEARS
Page of 2