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

    Stop!Watch®
    information

    Instructions
    for use