"Oklahoma Vfc Monthly Refrigerator Temperature Log" - Oklahoma

Oklahoma Vfc Monthly Refrigerator Temperature Log is a legal document that was released by the Oklahoma State Department of Health - a government authority operating within Oklahoma.

Form Details:

  • Released on February 1, 2018;
  • The latest edition currently provided by the Oklahoma State 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 Oklahoma State Department of Health.

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Oklahoma VFC Monthly Refrigerator Temperature Log
Month/Year: ___________/_________
Refrigerator Location/ID: ______________
VFC Pin: _________________________
Clinic: ______________________________
*Take action immediately if
Day of the
Staff
≥36°
≤46°
temperature is too high or low!
Month
Time
Initials
Min
Max
Alarm/Action Taken
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Instructions for completing the monthly temperature log.
1. Complete the top of the form with the month/year, refrigerator id/location, VFC Pin, and name of clinic.
2. Record min/max temperatures daily at opening of the clinic in Fahrenheit.
3. Clear min/max temperature daily after recording the temperatures on the temperature log.
4. Download data logger data regularly and save to computer file. (Temp logs and data logger information
must be kept for 3 years.
5. For out of range temperatures refer to the VSIR Decision Tree for guidance and action to take.
_____________________________________________
Name of person completing form:
Signature:
___________________________________
Date: _______________________
February 2018
Oklahoma VFC Monthly Refrigerator Temperature Log
Month/Year: ___________/_________
Refrigerator Location/ID: ______________
VFC Pin: _________________________
Clinic: ______________________________
*Take action immediately if
Day of the
Staff
≥36°
≤46°
temperature is too high or low!
Month
Time
Initials
Min
Max
Alarm/Action Taken
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Instructions for completing the monthly temperature log.
1. Complete the top of the form with the month/year, refrigerator id/location, VFC Pin, and name of clinic.
2. Record min/max temperatures daily at opening of the clinic in Fahrenheit.
3. Clear min/max temperature daily after recording the temperatures on the temperature log.
4. Download data logger data regularly and save to computer file. (Temp logs and data logger information
must be kept for 3 years.
5. For out of range temperatures refer to the VSIR Decision Tree for guidance and action to take.
_____________________________________________
Name of person completing form:
Signature:
___________________________________
Date: _______________________
February 2018
Oklahoma VFC Monthly Refrigerator Temperature Log
Month/Year: ___________/_________
Refrigerator Location/ID: ______________
VFC Pin: _________________________
Clinic: ______________________________
*Take action immediately if
Day of the
Staff
≥36°
≤46°
temperature is too high or low!
Month
Initials
Min
Max
Alarm/Action Taken
Time
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Instructions for completing the monthly temperature log.
1. Complete the top of the form with the month/year, refrigerator id/location, VFC Pin, and name of clinic.
2. Record min/max temperatures daily at opening of the clinic in Fahrenheit.
3. Clear min/max temperature daily after recording the temperatures on the temperature log.
4. Download data logger data regularly and save to computer file. (Temp logs and data logger information
must be kept for 3 years.
5. For out of range temperatures refer to the VSIR Decision Tree for guidance and action to take.
_____________________________________________
Name of person completing form:
Signature:
___________________________________
Date: _______________________
February 2018
Oklahoma VFC Monthly Freezer Temperature Log
Month/Year: ___________/_________
Freezer Location/ID: _________________
VFC Pin: _________________________
Clinic: ______________________________
*Take action immediately if
Day of the
Staff
≤5°
temperature is too high or low!
Month
Time
Initials
Min
Max
Alarm/Action Taken
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Instructions for completing the monthly temperature log.
1. Complete the top of the form with the month/year, freezer id/location, VFC Pin, and name of clinic.
2. Record min/max temperatures daily at opening of the clinic in Fahrenheit.
3. Clear min/max temperature daily after recording the temperatures on the temperature log.
4. Download data logger data regularly and save to computer file. (Temp logs and data logger information
must be kept for 3 years.
5. For out of range temperatures refer to the VSIR Decision Tree for guidance and action to take.
_____________________________________________
Name of person completing form:
Signature:
___________________________________
Date: _______________________
February 2018
Oklahoma VFC Monthly Freezer Temperature Log
Month/Year: ___________/_________
Freezer Location/ID: _________________
VFC Pin: _________________________
Clinic: ______________________________
*Take action immediately if
Day of the
Staff
≤5°
temperature is too high or low!
Month
Initials
Min
Max
Alarm/Action Taken
Time
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Instructions for completing the monthly temperature log.
1. Complete the top of the form with the month/year, freezer id/location, VFC Pin, and name of clinic.
2. Record min/max temperatures daily at opening of the clinic in Fahrenheit.
3. Clear min/max temperature daily after recording the temperatures on the temperature log.
4. Download data logger data regularly and save to computer file. (Temp logs and data logger information
must be kept for 3 years.
5. For out of range temperatures refer to the VSIR Decision Tree for guidance and action to take.
_____________________________________________
Name of person completing form:
Signature: ____________________________________
Date: _______________________
February 2018
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