[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-165522-en":3,"doc-seo-165522-105":29,"detail-sidebar-cat-1-en-105":89},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":11,"category_id":12,"category_name":13,"doc_title":14,"doc_description":15,"doc_content":16,"file_id":17,"file_url":18,"file_type":19,"file_size":20,"view_count":4,"is_deleted":4,"is_public":11,"is_downloadable":11,"audit_status":11,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":15,"update_tm":28,"read_time":11},165522,5909887256941,"Mason","https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc",1,17,"Forms","Appendix D - Cold Chain Breach Assessment Checklist","This checklist outlines actions and information required when a cold chain incident is discovered, including quarantining and marking vaccines “DO NOT USE,” relocating them to a monitored refrigerator maintaining +2°C to +8°C, and submitting incident documentation to Public Health with a completed 30-day temperature log. It guides provider interview questions, data capture for medical review, and operational assessment steps in Panorama. It also covers recommendations, notification timelines, vaccine handling decisions, return of non-viable stock, and labeling of viable exposed vaccines.","Provider Info\nName: _____________________________________________\tPhone: ______________\nDate: _____________\t\tOff-Site Monitoring? _____________\t ASC#: ___________\nThe provider discovering a cold chain incident will:\nImmediately relocate the vaccine to a working/monitored fridge able of maintaining +2°C to +8°C.\nQuarantine the vaccine and mark “DO NOT USE” until the assessment is completed.\nDocument the incident on the Cold Chain Report Form (Appendix A) and submit to Public Health\nFax or email a completed 30-day temperature log for the affected fridge to Public Health.\nQuestions to ask provider:\nWas the vaccine quarantined and marked as “DO NOT USE”?\nWere there any open vials of vaccine?\nWas the vaccine moved to a monitored working fridge (+2°C to +8°C)?\nHas the vaccine been exposed to any previous cold chain excursions?\nWas the vaccine left at room temperature? If so, how long and what is the recorded room temperature?\nWhen was the last time the fridge had maintenance performed?\nWhen was the last time the min/max thermometer’s batteries were changed/recalibrated? What type of min/max thermometer do they use?\nWhat staff is responsible for vaccine fridge and monitoring the vaccine fridge?\nDo you have a back-up plan to store vaccine in case of emergency? (i.e., power outage, etc.)\nWhat type of fridge is the vaccine stored in?\nIs there any upcoming clinics requiring the exposed vaccine?  If so when and do you have unaffected vaccine to use?\nWere any of the affected vaccines administered after the initial exposure? If so: When, and what vaccines?\nWas the Vaccine Cold Chain Failure Incident report (Appendix A) completed and faxed or emailed along with current and previous months temperature logs?\nNotify provider the assessment will take 5 to 7 business days after they have submitted all information.\nTake note of who you were talking to, date and time for documentation purposes.\nInformation for the Medical Information Specialist:\nVaccine Name, lot # and expiry date\nNumber of doses of each vaccine\nWas the vaccine punctured or unpunctured?\nCause of the temperature excursion\nLength of temperature excursion\nWas the affected vaccine involved in a previous temperature excursion?\nThe min/max temperature for the excursion\nWas the affected vaccine administered to patients?\nHas the vaccine been quarantined?\nAsk for a reference number.\nAsk for information to be emailed for documentation purposes.\nTake note of the name of the Medical Information Specialist, date, and time\nThe BioDepot RPhT/PPA:\nCreate a cold chain incident (Adverse Storage Condition) in Panorama.\nUpload all documents to the ASC (the Cold Chain Report Form, and temperature log) and any details about previous cold chains.\nIn the comments section of the ASC include if the cold chain was reported by the provider or identified via temperature log submission.\nDocument every telephone call and email with the provider and Medical Information Specialists in the comments section of the ASC (include date, time, who you talked to and if messages were left).\nAssess and analyze the cold chain report to determine length of time and temperature extremes of the exposure, prior excursions of the vaccines (double check Panorama), functionality/reliability of the vaccine fridge and min/max temperature monitor.\nDetermine cost of vaccine loss. Vaccine loss is only reported if capturing the cost of more than one vaccine product. Include this information in the comments of the ASC.\nIf non-viable vaccine was used for immunization, consult with the Zonal Health Protection Nurse (see SOP for information that is required to submit to Zonal Health Protection Nurse) and they will provide an SBAR to the MOH to determine if reimmunization needs to be considered.\nReport any loss of over $5000.00 to the Immunization Consultant.\nWhen the assessment is complete, upload the Cold Chain summary letter to the ASC.\nUpdate the cold chain assessment information in the rotating cold chain schedule, and mark as complete.\n","cbCainrkxqeGC5QM","https://ap.wps.com/l/cbCainrkxqeGC5QM","docx",34499,3,"English","en",105,"# Provider actions and documentation\n## Provider questions to guide assessment\n# Medical Information Specialist inputs\n# BioDepot RPhT/PPA assessment workflow","[{\"question\":\"What immediate steps must be taken when a provider discovers a cold chain incident?\",\"answer\":\"The vaccine must be relocated to a monitored fridge maintaining +2°C to +8°C, quarantined, and marked “DO NOT USE” until assessment is completed.\"},{\"question\":\"Which provider questions are used to evaluate the cold chain exposure?\",\"answer\":\"Questions cover quarantine and “DO NOT USE” marking, presence of open vials, whether vaccines were moved to a monitored fridge, prior cold chain excursions, time left at room temperature, maintenance history, thermometer battery/calibration details, staff responsibilities, and emergency backup plans.\"},{\"question\":\"What does the BioDepot RPhT/PPA do after information is submitted?\",\"answer\":\"They create an Adverse Storage Condition in Panorama, upload the Cold Chain Report Form and temperature log, document calls/emails in the ASC comments, analyze temperature extremes and excursion duration, assess fridge functionality, estimate vaccine loss when applicable, upload the cold chain summary letter, update the rotating schedule as complete, and report findings to the provider.\"}]","Appendix D - Cold Chain Breach Assessment Checklist | DOCX",1788173013,{"code":4,"msg":30,"data":31},"ok",{"site_id":24,"language":23,"slug":32,"title":14,"keywords":33,"description":15,"schema_data":34,"social_meta":84,"head_meta":86,"extra_data":88,"updated_unix":28},"appendix-d-cold-chain-breach-assessment-checklist","",{"@graph":35,"@context":83},[36,52,66],{"@type":37,"itemListElement":38},"BreadcrumbList",[39,43,47,49],{"item":40,"name":41,"@type":42,"position":11},"https://docshare.wps.com","Home","ListItem",{"item":44,"name":45,"@type":42,"position":46},"https://docshare.wps.com/template/","Template",2,{"item":48,"name":13,"@type":42,"position":21},"https://docshare.wps.com/template/forms/",{"item":50,"name":14,"@type":42,"position":51},"https://docshare.wps.com/template/appendix-d-cold-chain-breach-assessment-checklist/165522/",4,{"url":50,"name":14,"@type":53,"author":54,"headline":14,"publisher":56,"fileFormat":59,"inLanguage":23,"description":15,"dateModified":60,"datePublished":60,"encodingFormat":59,"isAccessibleForFree":61,"interactionStatistic":62},"DigitalDocument",{"name":9,"@type":55},"Person",{"url":40,"name":57,"@type":58},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-08-31",true,{"@type":63,"interactionType":64,"userInteractionCount":4},"InteractionCounter",{"@type":65},"ViewAction",{"@type":67,"mainEntity":68},"FAQPage",[69,75,79],{"name":70,"@type":71,"acceptedAnswer":72},"What immediate steps must be taken when a provider discovers a cold chain incident?","Question",{"text":73,"@type":74},"The vaccine must be relocated to a monitored fridge maintaining +2°C to +8°C, quarantined, and marked “DO NOT USE” until assessment is completed.","Answer",{"name":76,"@type":71,"acceptedAnswer":77},"Which provider questions are used to evaluate the cold chain exposure?",{"text":78,"@type":74},"Questions cover quarantine and “DO NOT USE” marking, presence of open vials, whether vaccines were moved to a monitored fridge, prior cold chain excursions, time left at room temperature, maintenance history, thermometer battery/calibration details, staff responsibilities, and emergency backup plans.",{"name":80,"@type":71,"acceptedAnswer":81},"What does the BioDepot RPhT/PPA do after information is submitted?",{"text":82,"@type":74},"They create an Adverse Storage Condition in Panorama, upload the Cold Chain Report Form and temperature log, document calls/emails in the ASC comments, analyze temperature extremes and excursion duration, assess fridge functionality, estimate vaccine loss when applicable, upload the cold chain summary letter, update the rotating schedule as complete, and report findings to the provider.","https://schema.org",{"og:url":50,"og:type":85,"og:title":14,"og:site_name":57,"og:description":15},"article",{"robots":87,"canonical":50},"index,follow",{"doc_id":7,"site_id":24},{"code":4,"msg":5,"data":90},[91,96,101,106,111,116,119,124,129],{"id":92,"doc_module":11,"doc_module_name":45,"category_name":93,"show_sort_weight":94,"slug":95},11,"Presentations",90,"presentations",{"id":97,"doc_module":11,"doc_module_name":45,"category_name":98,"show_sort_weight":99,"slug":100},12,"Resumes",80,"resumes",{"id":102,"doc_module":11,"doc_module_name":45,"category_name":103,"show_sort_weight":104,"slug":105},14,"Invoices",70,"invoices",{"id":107,"doc_module":11,"doc_module_name":45,"category_name":108,"show_sort_weight":109,"slug":110},15,"Posters",60,"posters",{"id":112,"doc_module":11,"doc_module_name":45,"category_name":113,"show_sort_weight":114,"slug":115},16,"Social Media",50,"social-media",{"id":12,"doc_module":11,"doc_module_name":45,"category_name":13,"show_sort_weight":117,"slug":118},40,"forms",{"id":120,"doc_module":11,"doc_module_name":45,"category_name":121,"show_sort_weight":122,"slug":123},18,"Letters",30,"letters",{"id":125,"doc_module":11,"doc_module_name":45,"category_name":126,"show_sort_weight":127,"slug":128},21,"Paper Templates",5,"papers-templates",{"id":130,"doc_module":11,"doc_module_name":45,"category_name":131,"show_sort_weight":4,"slug":132},158,"General","general-158"]