Appendix 20. Cold chain evaluation/inventory

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    Country: ___________________________________ Province/region:  _____________________

    District: ____________________________________ Health care facility: ___________________

    Person in charge: ___________________________ Date: _______________________________

     

     YesNo

    1 - Is there a person in charge of the cold chain?

    If yes, person’s name and contact information:

     

    		  
    2 - Is the room well-ventilated?  
    3 - Is the equipment protected from the sun?  
    4 - If electricity is available, is it reliable?
    Specify the number of hours of electricity per day:    		  
    5 - Is the distance between the wall and the refrigerator/freezer greater than or equal to 25 cm?  


    6 - Refrigerators:

     


    Brand, model
    Number

    Energy
    source (a)Citation a.Specify the energy source, the electrical power and the availability (number of hours/day).

    		Net storage
    volume
    (in litres)    		Net available
    volume
    (in litres)

    Monitoring equipment 
    present
    Y/N (b)Citation b.One thermometer, one Stop!Watch® card with a Freeze-tag® and one temperature monitoring sheet per refrigerator.

          
          
          
          
          

    7 - Freezers:

     

    Brand, modelNumber

    Energy
    source (c)Citation c.Specify the energy source, the electrical power and the availability (number of hours/day).

    		Storage
    volume    		Ice production
    per 24 hours

    Monitoring equipment
    present
    Y/N (d)Citation d.One thermometer and one temperature monitoring sheet per freezer.

    In litresIn nb
    0.6-litre
    ice
    packs    		In
    kg/24h
         		In of
    0.6-litre
    ice
    packs
            
            
            
            
            
            

    8 - Transport equipment:

     

    Vaccine carrier, brand and modelTotal numberNumber availableVaccine storage
    volume (in litres)
        
        
        
    Cold box, brand and modelTotal numberNumber available 
        
        
        
    Ice packsTotal numberNumber available 
    0.6 litre   
    0.4 litre   

    Other (specify volume)

     

    		   


    9 - Monitoring equipment:

     

    EquipmentBrand and modelTotal number
    available/functional
    Temperature logger  
    Moeller® alcohol thermometer  
    Thermometer with liquid-crystal display (LCD)  
    Refrigerator monitoring card 
    (Stop!Watch® with Freeze-tag®)    		  
    Freeze indicator (Freeze-tag®)  
    Remote temperature monitor 
    (LogTag WiFi®, Mobeye®,Blulog®)    		  
    • aSpecify the energy source, the electrical power and the availability (number of hours/day).
    • bOne thermometer, one Stop!Watch® card with a Freeze-tag® and one temperature monitoring sheet per refrigerator.
    • cSpecify the energy source, the electrical power and the availability (number of hours/day).
    • dOne thermometer and one temperature monitoring sheet per freezer.
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