Appendix 42. Cold chain failure report

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Name and position of person reporting:___________________________________________

District/region: ______________________________________________________________

Incident date and location: _____________________________________________________

Refrigerator type: ____________________________________________________________

Incident summary (circumstances, source of the problem, temperature noted, times, etc.):

 

 

 

 

 

Actions taken to fix the problem:

 

 

 

 

List of products and information:

 

Item code Item Manufacturer

Lot
no.

Quantity

Price
/unit

Total
value

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