Vaccine Cold Chain Maintenance Inspection Report Search Submit Search Print this Page Home » For Professionals » Health Care & Dental Professionals » Immunization Resources » Vaccine Cold Chain Maintenance Inspection Report Premises InformationHolding Point Number Name of Premises(Required) Date Type of Inspection Initial Re-inspection Reinspection Number Number of Refrigerators in this Premises This inspection if for Refrigerator no./ID Premises Contact Information(Required) First Name Last Name Premises Contact Information Street Address Unit Number City/Town AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Telephone Number(Required)Extension Fax Number Email Address(Required) Temperature Monitoring Device Max-min Thermometer Data Logger Other Type of Refrigerator Bar Style Domestic Purpose Built Bar Style Refrigerator Separate Freezer Combined Freezer Refrigerator Only Domestic Refrigerator Separate Freezer Combined Freezer Age of Refrigerator 0 years to less than 1 year 1 year to less than 5 years 5 years to less than 10 years Greater than 10 years Premises Type Physician Offer (FP) Physician Office (PED) Family Health Team Long-Term Care Home Hospital Community Health Centre Correctional Facility Addiction Treatment Centre Nursing Agency Occupational Health First Nations Facility Retirement Home Walk-in Clinic Public Health Unit School Pharmacy Other Number of Immunizers Section 1: Vaccine Refrigerators Temperatures and Readings1 a. Temperature monitoring device is present and is able to record current, maximum, and minimum temperatures. Yes, compliant No 1 a. Strategies/Action Taken Premises given a temperature monitoring device or advised to obtain a temperature monitoring device. Conducted a cold chain incident inspection Implemented troubleshooting measures 1 b. Current temperature of refrigerator using premises' temperature monitoring device (degrees Celsius) 1 b. Current temperature of refrigerator using public health unit's temperature monitoring device (degrees Celsius) 1 b. Temperature variance between public health unit's temperature monitoring device and premises (degrees Celsius) 1 b. Compliant Yes No 1 b. Strategies/Action Taken Replaced premises' temperature monitoring device battery Replaced premises' temperature monitoring device Accuracy of the premises' temperature monitoring device was tested using the slush test 1 c. Temperature variances between public health unit's temperature monitoring device and premises' temperature monitoring device is no greater than +/-2 degrees Celsius Yes No Note for public health units: the degree of variability is dependent on the devices that are being checked for accuracy. Refer to pages 25-27 in the Vaccine Storage Handling Guidance document.1 c. Strategies/Actions Taken Conducted a cold chain inspection Implemented trouble shooting measures Instructed to change batteries every 6 months 1 d. Maximum-minimum thermometer sensor and/or data logger is properly located. Yes No 1 d. Strategies/Actions Taken Placed maximum-minimum thermometer sensor on the middle shelf inside an empty vaccine box. Labelled the vaccine box as empty Placed data logger on the middle shelf Conducted a cold chain incident inspection Implemented troubleshooting measures Rating for Section 1 Pass Conditional Fail Section 1 CommentsSection 2: Log Book Review2 a. Temperature log book present Yes No 2 a. Strategies/Actions Taken Given Temperature Log Book 2 b. Current, maximum and minimum temperatures are checked twice daily and documented with initials and time in the temperature Log Book Yes No 2 b. Strategies/Actions Taken Instructed to record maximum, minimum and current temperatures twice daily (at the beginning and end of each business day) and the time that the temperatures were taken in Temperature Log Book Instructed to view temperatures every time the refrigerator is opened Conducted a cold chain incident inspection 2 c. Current, maximum and minimum temperatures are maintained between +2 degrees Celsius and +8 degrees Celsius Yes No 2 c. Strategies/Actions Taken Instructed premises to notify the public health unit when temperatures are outside the required range Conducted a cold chain incident inspection Implemented troubleshooting measures Suspended vaccine ordering 2 c. Number of days vaccine ordering is suspended 2 d. Maximum-minimum thermometer is being reset twice daily and/or the data logger's continuous temperature readings are being downloaded as required Yes No 2 d. Strategies/Actions Taken Provided education regarding the importance of resetting the maximum-minimum thermometer twice daily after recording minimum and maximum temperatures Provided education regarding the importance of downloading the continuous temperature readings from the data logger Conducted a cold chain incident inspection 2 e. Office staff demonstrates resetting and/or downloading data from the temperature monitoring device Yes No 2 e. Strategies/Actions Taken Provided temperature monitoring device resetting/downloading instructions/demonstration Conducted a cold chain incident inspection 2 f. Office staff demonstrates reading temperature monitoring device Yes No 2 f. Strategies/Actions Taken Provided temperature monitoring device reading instructions/demonstration Conducted a cold chain incident inspection Rating for Section 2 Pass Conditional Fail Section 2 CommentsSection 3: Ministry Cold Chain Material3 a. How to monitor your refrigerator temperature sticker is mounted on exterior of vaccine refrigerator Yes No 3 a. Strategies/Actions Taken Given How to monitor your refrigerator temperature sticker and placed on exterior of vaccine refrigerator 3 b. Protect your vaccines - Protect your patients poster is mounted on exterior of vaccine refrigerator Yes No 3 b. Strategies/Actions Taken Given Protect your vaccines - Protect your patients poster and placed on exterior of vaccine refrigerator 3 c. Vaccine Storage and Handling Guidelines is on hand Yes No 3 c. Strategies/Actions Taken Given Vaccine Storage and Handling Guidelines 3 d. Vaccine Refrigerator Maintenance Log Book is on hand Yes No 3 d. Strategies/Actions Taken Given Vaccine Refrigerator Maintenance Log Book 3 e. i. Insulated vaccine container(s) with packing material and a temperature monitoring device is present Yes No 3 e. i. Strategies/Actions Taken Given or advised to obtain insulated vaccine container(s) with packing material (i.e., ice packs) and temperature monitoring device(s) 3 e. ii. Insulated vaccine container(s) with packing material and a temperature monitoring device is used when transporting vaccines Yes No 3 e. ii. Strategies/Actions Taken Given or advised to obtain insulated vaccine container(s) with packing material (i.e., ice packs) and temperature monitoring device(s) Rating for Section 3 Pass Conditional Fail Section 3 CommentsSection 4: Organization of RefrigeratorIs there vaccine currently stored in this holding point? Yes - continue on with Section 4 No - skip to Section 5 4 a. Publicly funded vaccines are stored in the middle of the refrigerator away from the walls, floors and cold air vents Yes No 4 a. Strategies/Actions Taken Placed publicly funded vaccines in the middle shelves away from the floor, cold air vents and 2 to 3 inches from the walls of the refrigerator 4 b. Publicly funded vaccines are stored on internal shelves of the refrigerator (not stored in the door or in drawers) Yes No 4 b. Strategies/Actions Taken Placed publicly funded vaccines in the middle shelves, away from the floor, cold air vents and 2 to 3 inches form the walls of the refrigerator 4 c. Publicly funded vaccines are organized by product Yes No 4 c. Strategies/Actions Taken Organized publicly funded vaccines by product 4 d. Drugs (including privately purchased vaccines) that require refrigeration between +2 degrees Celsius to +8 degrees Celsius may be stored in the refrigerator with publicly funded vaccines. The refrigerator must have capacity to store the drugs without compromising the safe storage of publicly funded vaccines. No food, beverages and/or medical/laboratory specimens can be stored with publicly funded vaccines Yes No 4 d. Strategies/Actions Taken Removed food, beverages and/or medical/laboratory specimens from the vaccine refrigerator and instructed not to store these items in the refrigerator with publicly funded vaccines 4 e. Space is maintained between each publicly funded vaccine product Yes No 4 e. Strategies/Actions Taken Ensured space is maintained between publicly funded vaccine products to allow for air circulation Removed excess publicly funded vaccine Advised that refrigerator has exceeded capacity to safety accommodate required stock and instructed to obtain larger or additional refrigerator Advised that refrigerator has exceeded capacity to safety accommodate required stock and instructed to obtain additional refrigerator to store publicly funded vaccines only Advised that refrigerator has exceeded capacity to safely accommodate required stock and instructed to order and stock less publicly funded vaccines and if applicable, drugs 4 f. Publicly funded vaccines and diluents are stored in original packaging Yes No 4 f. Strategies/Actions Taken Ensured publicly funded vaccines and diluents are stored in original packaging to protect vaccines from light 4 g. Publicly funded vaccine with the longest expiry dates are placed behind shorter-dated publicly funded vaccines Yes No 4 g. Strategies/Actions Taken Instructed to rotate publicly funded vaccine supply by placing publicly funded vaccine with the longest expiry dates behind shorter-dated publicly funded vaccines 4 h. Use publicly funded vaccine that has been previously exposed to a cold chain incident first Yes No 4 h. Strategies/Actions Taken Instructed to use publicly funded vaccines that have been previously exposed to a cold chain incident first 4 i. Only current dated publicly funded vaccines present in refrigerator (no expired publicly funded vaccines) Yes No 4 i. Strategies/Actions Taken Removed expired publicly funded vaccine Instructed to return expired publicly funded vaccines to the public health unit or OGPMSS 4 j. Water bottles placed on empty shelves and in refrigerator door Yes No 4 j. Strategies/Actions Taken Instructed to place or placed cooler water bottles in the refrigerator's empty shelves and doors 4 k. Refrigerator type and size is sufficient to accommodate required stock Yes No 4 k. Strategies/Actions Taken Advised that refrigerator has exceeded capacity to safely accommodate required stock Instructed to obtain larger or additional refrigerator Instructed to obtain additional refrigerator to store publicly funded vaccine only Instructed to order and stock less publicly funded vaccines and if applicable, drugs 4 l. No more than 1 month supply of publicly funded vaccines is in stock Yes No 4 l. Strategies/Actions Taken Inventory control measures have been taken by the public health unit Rating for Section 4 Pass Conditional Fail Section 4 CommentsSection 5: Vaccine Handling Review5 a. Office staff know to remove publicly funded vaccines from refrigerator for immediate use only Yes No 5 a. Strategies/Actions Taken Instructed to only remove publicly funded vaccines from the refrigerator for immediate use 5 b. Multi-dose publicly funded vaccine vials (if present in refrigerator) are marked with the date opened and discarded within 30 days or as per manufacturer's instructions Yes No 5 b. Strategies/Actions Taken Instructed to mark multi-dose publicly funded vaccine vials with the date opened and dispose as per manufacturer's instructions Rating for Section 5 Pass Conditional Fail Section 5 CommentsSection 6: General6 a. i. Refrigerator should be optimally placed in an area that is well ventilated Yes No 6 a. ii. Refrigerator should be optimally placed away from direct sunlight Yes No 6 a. iii. Refrigerator should be optimally placed away from external walls Yes No 6 a. Strategies/Actions Taken Instructed to relocate refrigerator to an area that is well ventilated Instructed to relocate refrigerator out from direct sunlight Instructed to relocate refrigerator away from external walls 6 b. Refrigerator door OR refrigerator room is locked at the end of the day Yes No 6 b. Strategies/Actions Taken Instructed to install lock on vaccine refrigerator or refrigerator room door 6 c. i. Refrigerator electrical outlet is covered by metal cage Yes No 6 c. ii. Refrigerator electrical outlet is not easily accessible Yes No 6 c. iii. Refrigerator electrical outlet is accessible but the Do Not Unplug sticker sign is posted beside refrigerator electrical outlet Yes No 6 c. Strategies/Actions Taken Ensured refrigerator's electrical outlet is covered by metal cage or is not easily accessible Given 'Do Not Unplug' sticker and placed beside refrigerator electrical outlet 6 d. i. Refrigerator maintenance is performed if applicable, freezer has been defrosted and ice is less than 1 cm thick Yes No 6 d. ii. Refrigerator maintenance is performed. Back (including the coils, if necessary), top and sides are cleaned and dusted Yes No 6 d. iii. Door is sealed tightly and properly and has adequate door seals Yes No 6 d. iii. Door is sealed tightly and properly and has velcro door latch installed (if required) Yes No 6 d. iii. Door is sealed tightly and properly and has tight door hinges Yes No 6 d. Strategies/Actions Taken Instructed to defrost refrigerator and move publicly funded vaccines to a monitored and insulated container while defrosting Instructed to dust and clean the back (including the coils, if necessary), top and sides of the refrigerator Instructed to replace door seals Instructed to install Velcro door latch Instructed to tighten door hinges 6 e. One office staff member and a backup person is responsible for vaccine management Yes No 6 e. Strategies/Actions Taken Assigned one office member and a backup person the responsibility of vaccine management 6 f. Office staff know to review existing publicly funded vaccine stock prior to each vaccine order Yes No 6 f. Strategies/Actions Taken Instructed to review existing publicly funded vaccine stock prior to each vaccine order 6 g. If applicable: Stocks of private and publicly funded vaccine should be clearly marked and/or separated Yes No 6 g. Strategies/Actions Taken Private and publicly funded vaccine supply is clearly marked and/or separated 6 h. Office staff know to contact public health unit immediately when publicly funded vaccines are exposed to temperatures below +2 degrees Celsius or above +8 degrees Celsius Yes No 6 h. Strategies/Actions Taken Instructed to report cold chain incidents to the public health unit Instructed to place publicly funded vaccine involved in a cold chain incident in a bag marked 'Do Not Use' Instructed to keep labeled bag of publicly funded vaccines in a monitored refrigerator or monitored insulated container until evaluated by the public health unit 6 i. Office staff know to return waster publicly funded vaccines to the public health unit (or to OGPMSS if premises is in the City of Toronto) for disposal Yes No 6 i. Strategies/Actions Taken Instructed to return wasted publicly funded vaccines to the public health unit or OGPMSS for disposal 6 j. Contingency (emergency) plan developed in the event of a vaccine refrigerator malfunction, power failure or other emergencies Yes No 6 j. Strategies/Actions Taken Discussed a contingency plan Premises instructed to establish a contingency plan 6 k. Health care providers are knowledgeable regarding reporting adverse events following immunization (AEFIs) to the public health unit Yes No 6 k. Strategies/Actions Taken Given Public Health Ontario's AEFI reporting fact sheet for health care providers Informed of Public Health Ontario's vaccine safety website (www.publichealthontario.ca/vaccinesafety/ Given ministry's parent vaccine safety information sheet to distribute to parents (if applicable) 6 l. Office staff are aware that only publicly funded vaccines that are ordered by the premises are stored in the premises and administered within the geographic boundaries of the public health unit. Yes No 6 l. Strategies/Actions Taken Instructed to only store publicly funded vaccines that was received by the premises. Instructed to not store publicly funded vaccine that the premises did not order. Instructed to administer publicly funded vaccines within the geographic boundaries of the public health unit. Rating for Section 6 Pass Conditional Fail Section 6 CommentsInventoryPublicly Funded Vaccines Act-Hib® Adacel® Adacel®-Polio Bexsero® Boostrix® Boostrix®-Polio Engerix B® Adolescent/Adult Engerix B® Pediatric Gardasil® 9 Havrix® Adult Havrix® Pediatric Imovax® Polio Imovax® Rabies Menactra® Menjugate® Menveo® Nimenrix® M-M-R® II NeisVac-C® Pediacel® Pneumovax® 23 Prevnar® 13 Priorix® Priorix Tetra™ ProQuad® RabAvert® Recombivax HB® Adolescent/Adult Recombivax HB® Pediatric Recombivax HB® Renal Rotarix™ Shingrix® Td Adsorbed Td Polio Tubersol® Varilrix® Varivax® III Alfuria Tetra Fluad® Flucelvax FluLaval Tetra Fluzone® QuadrivalentHD Fluzone® Quadrivalent HiddenAct-Hib® Cost per doseAct-Hib® Number of Expired DosesAct-Hib® Total Value of Expired DosesAct-Hib® Number of Non Expired DosesAct-Hib® Total Value of Non Expired DosesHiddenAdacel® Cost per doseAdacel® Number of Expired DosesAdacel® Total Value of Expired DosesAdacel® Number of Non Expired DosesAdacel® Total Value of Non Expired DosesHiddenAdacel® -Polio Cost per doseAdacel® -Polio Number of Expired DosesAdacel® -Polio Total Value of Expired DosesAdacel® -Polio Number of Non Expired DosesAdacel® -Polio Total Value of Non Expired DosesHiddenBexsero® Cost per doseBexsero® Number of Expired DosesBexsero® Total Value of Expired DosesBexsero® Number of Non Expired DosesBexsero® Total Value of Non Expired DosesHiddenBoostrix® Cost per doseBoostrix® Number of Expired DosesBoostrix® Total Value of Expired DosesBoostrix® Number of Non Expired DosesBoostrix® Total Value of Non Expired DosesHiddenBoostrix® -Polio Cost per doseBoostrix® -Polio Number of Expired DosesBoostrix® -Polio Total Value of Expired DosesBoostrix® -Polio Number of Non Expired DosesBoostrix® -Polio Total Value of Non Expired DosesHiddenEngerix B® Adolescent/Adult Cost per doseEngerix B® Adolescent/Adult Number of Expired DosesEngerix B® Adolescent/Adult Total Value of Expired DosesEngerix B® Adolescent/Adult Number of Non Expired DosesEngerix B® Adolescent/Adult Total Value of Non Expired DosesHiddenEngerix B® Pediatric Cost per doseEngerix B® Pediatric Number of Expired DosesEngerix B® Pediatric Total Value of Expired DosesEngerix B® Pediatric Number of Non Expired DosesEngerix B® Pediatric Total Value of Non Expired DosesHiddenGardasil® 9 Cost per doseGardasil® 9 Number of Expired DosesGardasil® 9 Total Value of Expired DosesGardasil® 9 Number of Non Expired DosesGardasil® 9 Total Value of Non Expired DosesHiddenHavrix® Adult Cost per doseHavrix® Adult Number of Expired DosesHavrix® Adult Total Value of Expired DosesHavrix® Adult Number of Non Expired DosesHavrix® Adult Total Value of Non Expired DosesHiddenHavrix® Pediatric Cost per doseHavrix® Pediatric Number of Expired DosesHavrix® Pediatric Total Value of Expired DosesHavrix® Pediatric Number of Non Expired DosesHavrix® Pediatric Total Value of Non Expired DosesHiddenImovax® Polio Cost per doseImovax® Polio Number of Expired DosesImovax® Polio Total Value of Expired DosesImovax® Polio Number of Non Expired DosesImovax® Polio Total Value of Non Expired DosesHiddenImovax® Rabies Cost per doseImovax® Rabies Number of Expired DosesImovax® Rabies Total Value of Expired DosesImovax® Rabies Number of Non Expired DosesImovax® Rabies Total Value of Non Expired DosesHiddenMenactra® Cost per doseMenactra® Number of Expired DosesMenactra® Total Value of Expired DosesMenactra® Number of Non Expired DosesMenactra® Total Value of Non Expired DosesHiddenMenjugate® Cost per doseMenjugate® Number of Expired DosesMenjugate® Total Value of Expired DosesMenjugate® Number of Non Expired DosesMenjugate® Total Value of Non Expired DosesHiddenMenveo® Cost per doseMenveo® Number of Expired DosesMenveo® Total Value of Expired DosesMenveo® Number of Non Expired DosesMenveo® Total Value of Non Expired DosesHiddenNimenrix® Cost per doseNimenrix® Number of Expired DosesNimenrix® Total Value of Expired DosesNimenrix® Number of Non Expired DosesNimenrix® Total Value of Non Expired DosesHiddenM-M-R® II Cost per doseM-M-R® II Number of Expired DosesM-M-R® II Total Value of Expired DosesM-M-R® II Number of Non Expired DosesM-M-R® II Total Value of Non Expired DosesHiddenNeisVac-C® Cost per doseNeisVac-C® Number of Expired DosesNeisVac-C® Total Value of Expired DosesNeisVac-C® Number of Non Expired DosesNeisVac-C® Total Value of Non Expired DosesHiddenPediacel® Cost per dosePediacel® Number of Expired DosesPediacel® Total Value of Expired DosesPediacel® Number of Non Expired DosesPediacel® Total Value of Non Expired DosesHiddenPneumovax® 23 Cost per dosePneumovax® 23 Number of Expired DosesPneumovax® 23 Total Value of Expired DosesPneumovax® 23 Number of Non Expired DosesPneumovax® 23 Total Value of Non Expired DosesHiddenPrevnar® 13 Cost per dosePrevnar® 13 Number of Expired DosesPrevnar® 13 Total Value of Expired DosesPrevnar® 13 Number of Non Expired DosesPrevnar® 13 Total Value of Non Expired DosesHiddenPriorix® Cost per dosePriorix® Number of Expired DosesPriorix® Total Value of Expired DosesPriorix® Number of Non Expired DosesPriorix® Total Value of Non Expired DosesHiddenPriorix Tetra™ Cost per dosePriorix Tetra™ Number of Expired DosesPriorix Tetra™ Total Value of Expired DosesPriorix Tetra™ Number of Non Expired DosesPriorix Tetra™ Total Value of Non Expired DosesHiddenProQuad® Cost per doseProQuad® Number of Expired DosesProQuad® Total Value of Expired DosesProQuad® Number of Non Expired DosesProQuad® Total Value of Non Expired DosesHiddenRabAvert® Cost per doseRabAvert® Number of Expired DosesRabAvert® Total Value of Expired DosesRabAvert® Number of Non Expired DosesRabAvert® Total Value of Non Expired DosesHiddenRecombivax HB® Adolescent/Adult Cost per doseRecombivax HB® Adolescent/Adult Number of Expired DosesRecombivax HB® Adolescent/Adult Total Value of Expired DosesRecombivax HB® Adolescent/Adult Number of Non Expired DosesRecombivax HB® Adolescent/Adult Total Value of Non Expired DosesHiddenRecombivax HB® Pediatric Cost per doseRecombivax HB® Pediatric Number of Expired DosesRecombivax HB® Pediatric Total Value of Expired DosesRecombivax HB® Pediatric Number of Non Expired DosesRecombivax HB® Pediatric Total Value of Non Expired DosesHiddenRecombivax HB® Renal Cost per doseRecombivax HB® Renal Number of Expired DosesRecombivax HB® Renal Total Value of Expired DosesRecombivax HB® Renal Number of Non Expired DosesRecombivax HB® Renal Total Value of Non Expired DosesHiddenRotarix™ Cost per doseRotarix™ Number of Expired DosesRotarix™ Total Value of Expired DosesRotarix™ Number of Non Expired DosesRotarix™ Total Value of Non Expired DosesHiddenShingrix® Cost per doseShingrix® Number of Expired DosesShingrix® Total Value of Expired DosesShingrix® Number of Non Expired DosesShingrix® Total Value of Non Expired DosesHiddenTd Adsorbed Cost per doseTd Adsorbed Number of Expired DosesTd Adsorbed Total Value of Expired DosesTd Adsorbed Number of Non Expired DosesTd Adsorbed Total Value of Non Expired DosesHiddenTd Polio Cost per doseTd Polio Number of Expired DosesTd Polio Total Value of Expired DosesTd Polio Number of Non Expired DosesTd Polio Total Value of Non Expired DosesHiddenTubersol® Cost per doseTubersol® Number of Expired DosesTubersol® Total Value of Expired DosesTubersol® Number of Non Expired DosesTubersol® Total Value of Non Expired DosesHiddenVarilrix® Cost per doseVarilrix® Number of Expired DosesVarilrix® Total Value of Expired DosesVarilrix® Number of Non Expired DosesVarilrix® Total Value of Non Expired DosesHiddenVarivax® III Cost per doseVarivax® III Number of Expired DosesVarivax® III Total Value of Expired DosesVarivax® III Number of Non Expired DosesVarivax® III Total Value of Non Expired DosesHiddenAlfuria Tetra Cost per doseAlfuria Tetra Number of Expired DosesAlfuria Tetra Total Value of Expired DosesAlfuria Tetra Number of Non Expired DosesAlfuria Tetra Total Value of Non Expired DosesHiddenFluad® Cost per doseFluad® Number of Expired DosesFluad® Total Value of Expired DosesFluad® Number of Non Expired DosesFluad® Total Value of Non Expired DosesHiddenFlucelvax Cost per doseFlucelvax Number of Expired DosesFlucelvax Total Value of Expired DosesFlucelvax Number of Non Expired DosesFlucelvax Total Value of Non Expired DosesHiddenFluLaval Tetra Cost per doseFluLaval Tetra Number of Expired DosesFluLaval Tetra Total Value of Expired DosesFluLaval Tetra Number of Non Expired DosesFluLaval Tetra Total Value of Non Expired DosesHiddenFluzone® Quadrivalent HD Cost per doseFluzone® Quadrivalent HD Number of Expired DosesFluzone® Quadrivalent HD Total Value of Expired DosesFluzone® Quadrivalent HD Number of Non Expired DosesFluzone® Quadrivalent HD Total Value of Non Expired DosesHiddenFluzone® Quadrivalent Cost per doseFluzone® Quadrivalent Number of Expired DosesFluzone® Quadrivalent Total Value of Expired DosesFluzone® Quadrivalent Number of Non Expired DosesFluzone® Quadrivalent Total Value of Non Expired DosesSubtotal Number of Expired Vaccines in this refrigeratorSubtotal Number of Non Expired Vaccines in this refrigeratorSubtotal Value of Expired Vaccines in this refrigeratorSubtotal Value of Non Expired Vaccines in this refrigeratorGrand Total of All Vaccines in this RefrigeratorGrand Total Value of All Vaccines in this RefrigeratorRecommendationsFinal Results of Inspection (Final Rating) Pass Conditional Fail SignatureName of Premises Contact Person First Name Last Name Signature Date Name of Public Health Unit Inspector Name First Name Last Name Inspector Email Address Inspector Signature Inspection Date CAPTCHA