Appendix 20. Cold chain evaluation/inventory

Country: ___________________________________ Province/region: _____________________

District: ____________________________________ Health care facility: ___________________

Person in charge: ____________________________ Date: ______________________________

	Yes	No
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 30 cm?

6 - Refrigerators:

Brand, model	Number	Energy source^a	Storage volume (in litres)	Available volume (in litres)	Monitoring equipment present Y/N^b

^a Specify the energy source, the electrical power and the availability (number of hours/day).
^b One thermometer, one Stop!Watch® card with a Freeze-tag® and one temperature monitoring sheet per refrigerator.

7 - Freezers:

Brand, model	Number	Energy source^a	Storage volume		Ice production per 24 hours		Monitoring equipment present Y/N^b
Brand, model	Number	Energy source^a	In litres	In nb 0.6-litre ice packs	In kg/24h without vaccines	In nb 0.6-litre ice packs	Monitoring equipment present Y/N^b

^a Specify the energy source, the electrical power and the availability (number of hours/day).
^b One thermometer and one temperature monitoring sheet per freezer.

8 - Transport equipment:

Vaccine carrier, brand and model	Total number	Number available	Vaccine storage volume (in litres)



Cold box, brand and model	Total number	Number available



Ice packs	Total number	Number available
0.6 litre
0.4 litre
Other (specify volume)

9 - Monitoring equipment:

Equipement	Total number available/functional
Fridge-Tag^® or Logtag^® (with display) temperature logger
Moeller^® alcohol thermometer
Thermometer with liquid-crystal display (LCD)
Other thermometer (specify):
Refrigerator monitoring card (Stop!Watch^® with Freeze-tag^®)
Freeze indicator (Freeze-tag^®)