See Toolbox
Country: ___________________________________ Province/region: _____________________
District: ____________________________________ Health care facility: ___________________
Person in charge: ___________________________ Date: _______________________________
| Yes | No | |
|---|---|---|
|
1 - Is there a person in charge of the cold chain?
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2 - Is the room well-ventilated? |
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3 - Is the equipment protected from the sun? |
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4 - If electricity is available, is it reliable? |
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5 - Is the distance between the wall and the refrigerator/freezer greater than or equal to 30 cm? |
6 - Refrigerators:
|
|
Number |
Energy |
Storage |
Available |
Monitoring equipment |
|---|---|---|---|---|---|
7 - Freezers:
|
Brand, model |
Number |
Energy |
Storage |
Ice production |
Monitoring equipment |
||
|---|---|---|---|---|---|---|---|
| In litres |
In nb |
In |
In nb |
||||
8 - Transport equipment:
| Vaccine carrier, brand and model | Total number |
Number available |
Vaccine storage |
|---|---|---|---|
| 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 |
|---|---|
| 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®) |
- 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.