Appendix 42. Cold chain failure report

See Toolbox

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 codeItemManufacturer

Lot
no.

Quantity

Price
/unit

Total
value

Stop!Watch®
information

Instructions
for use