"Medication Refrigeration Temperature Log - Rx"

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MEDICATION REFRIGERATOR TEMPERATURE LOG
Department / Location: ______________________
Year: _____
Month: _________
Acceptable temperature range: 36 ° - 46˚ F
Acceptable Range
Actual Temp
Status (circle)
Day/Month
Time
Initials
Corrective Action Taken, if necessary
01
36˚ - 46˚ F
Good / Out-of-Range
02
36˚ - 46˚ F
Good / Out-of-Range
03
36˚ - 46˚ F
Good / Out-of-Range
04
36˚ - 46˚ F
Good / Out-of-Range
05
36˚ - 46˚ F
Good / Out-of-Range
06
36˚ - 46˚ F
Good / Out-of-Range
07
36˚ - 46˚ F
Good / Out-of-Range
08
36˚ - 46˚ F
Good / Out-of-Range
09
36˚ - 46˚ F
Good / Out-of-Range
10
36˚ - 46˚ F
Good / Out-of-Range
11
36˚ - 46˚ F
Good / Out-of-Range
12
36˚ - 46˚ F
Good / Out-of-Range
13
36˚ - 46˚ F
Good / Out-of-Range
14
36˚ - 46˚ F
Good / Out-of-Range
15
15
36˚ - 46˚ F
36˚ - 46˚ F
Good / Out-of-Range
Good / Out-of-Range
16
36˚ - 46˚ F
Good / Out-of-Range
17
36˚ - 46˚ F
Good / Out-of-Range
18
36˚ - 46˚ F
Good / Out-of-Range
19
36˚ - 46˚ F
Good / Out-of-Range
20
36˚ - 46˚ F
Good / Out-of-Range
21
36˚ - 46˚ F
Good / Out-of-Range
22
36˚ - 46˚ F
Good / Out-of-Range
23
36˚ - 46˚ F
Good / Out-of-Range
24
36˚ - 46˚ F
Good / Out-of-Range
25
36˚ - 46˚ F
Good / Out-of-Range
26
36˚ - 46˚ F
Good / Out-of-Range
27
36˚ - 46˚ F
Good / Out-of-Range
28
36˚ - 46˚ F
Good / Out-of-Range
29
36˚ - 46˚ F
Good / Out-of-Range
30
36˚ - 46˚ F
Good / Out-of-Range
31
36˚ - 46˚ F
Good / Out-of-Range
The temperature of each medication refrigerator must be checked daily and recorded on this log. If closed on a particular day, write "CLOSED" under Actual Temp
on temperature monitoring log. If an out-of-range temperature is found, notify Clinical Engineering and document your response.
Revised 01/2013
MEDICATION REFRIGERATOR TEMPERATURE LOG
Department / Location: ______________________
Year: _____
Month: _________
Acceptable temperature range: 36 ° - 46˚ F
Acceptable Range
Actual Temp
Status (circle)
Day/Month
Time
Initials
Corrective Action Taken, if necessary
01
36˚ - 46˚ F
Good / Out-of-Range
02
36˚ - 46˚ F
Good / Out-of-Range
03
36˚ - 46˚ F
Good / Out-of-Range
04
36˚ - 46˚ F
Good / Out-of-Range
05
36˚ - 46˚ F
Good / Out-of-Range
06
36˚ - 46˚ F
Good / Out-of-Range
07
36˚ - 46˚ F
Good / Out-of-Range
08
36˚ - 46˚ F
Good / Out-of-Range
09
36˚ - 46˚ F
Good / Out-of-Range
10
36˚ - 46˚ F
Good / Out-of-Range
11
36˚ - 46˚ F
Good / Out-of-Range
12
36˚ - 46˚ F
Good / Out-of-Range
13
36˚ - 46˚ F
Good / Out-of-Range
14
36˚ - 46˚ F
Good / Out-of-Range
15
15
36˚ - 46˚ F
36˚ - 46˚ F
Good / Out-of-Range
Good / Out-of-Range
16
36˚ - 46˚ F
Good / Out-of-Range
17
36˚ - 46˚ F
Good / Out-of-Range
18
36˚ - 46˚ F
Good / Out-of-Range
19
36˚ - 46˚ F
Good / Out-of-Range
20
36˚ - 46˚ F
Good / Out-of-Range
21
36˚ - 46˚ F
Good / Out-of-Range
22
36˚ - 46˚ F
Good / Out-of-Range
23
36˚ - 46˚ F
Good / Out-of-Range
24
36˚ - 46˚ F
Good / Out-of-Range
25
36˚ - 46˚ F
Good / Out-of-Range
26
36˚ - 46˚ F
Good / Out-of-Range
27
36˚ - 46˚ F
Good / Out-of-Range
28
36˚ - 46˚ F
Good / Out-of-Range
29
36˚ - 46˚ F
Good / Out-of-Range
30
36˚ - 46˚ F
Good / Out-of-Range
31
36˚ - 46˚ F
Good / Out-of-Range
The temperature of each medication refrigerator must be checked daily and recorded on this log. If closed on a particular day, write "CLOSED" under Actual Temp
on temperature monitoring log. If an out-of-range temperature is found, notify Clinical Engineering and document your response.
Revised 01/2013