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Section 1: Important Contacts (Disease Prevention & Control - San Francisco Department of Public Health)

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Vaccine Management Plan
www.eziz.org
1
Adapted by SFDPH, IMM-1122 (12/17)
KEEP YOUR MANAGEMENT PLAN NEAR THE VACCINE STORAGE UNITS
The SFDPH Immunization Program requires each practice to maintain a vaccine management plan for routine and
emergency situations. This template includes space for information about the practice such as guidelines,
protocols, contact information, and staff training. SFDPH Representatives may ask to review it during compliance
and storage and handling site visits.
Instructions: Review and update your plan at least once a year. Ensure that all content in each section (including
emergency contact information and alternate vaccine storage location) is up to date. Make sure key practice staff sign
and acknowledge the signature log whenever your plan is revised.
Section 1: Important Contacts
KEY PRACTICE STAFF & ROLES
Office/Practice Name
Address
Role
Name
Title
Phone #
Alt Phone #
E-mail
Medical Director
Vaccine Coordinator
Backup Vaccine
Coordinator
Receives vaccines
Stores vaccines
Monitors storage unit
tem
peratures
USEFUL EMERGENCY NUMBERS
Service Name Phone # Alt Phone # E-mail
SFDPH Immunization Program Main Line
Utility Company
Building Maintenance
Building Alarm Company
Refrigerator/Freezer Alarm Company
Refrigerator/Freezer Repair
Point of Contact for Vaccine Transport
Monitors storage unit
temperatures
Monitors storage unit
temperatures
Monitors storage unit
temperatures
415-554-2955
415-554-2724
Tina Milton
tina.milton@sfdph.org
SFDPH Immunization Program Urgent Issues
Kacy Diouf
415-554-2824
or
kacy.diouf@sfdph.org
immunization.dph@sfdph.org
Vaccine Management Plan
www.eziz.org
2
Adapted by SFDPH, IMM-1122 (12/17)
Section 2: Equipment Documentation
VACCINE STORAGE UNIT/LOCATIONS AND MAINTENANCE
Maintenance/Repair Company Phone
Unit Type
Unit/Location ID
Model
Type of Service
Refrigerator
Refrigerator
Refrigerator
Refrigerator
Freezer
Freezer
Freezer
Freezer
Location of completed
temperature logs
TEMPERATURE MONITORING DEVICE (DATA LOGGER) MAINTENANCE
Calibration
Company/Laboratory
Contact Phone
Calibration
Company/Laboratory
Contact Phone
Location of Certificates of
Calibration
Location of Backup
Data Logger
Temperature Monitoring Device
Model/Serial Number
Primary?
Backup?
Calibration
Expiration
Date
Alarm Setting
Low
Alarm Setting
High
Vaccine Management Plan
www.eziz.org
3
Adapted by SFDPH, IMM-1122 (12/17)
Section 3: Worksheet for Emergency Vaccine Management
The following sections include space for information and necessary actions to take in the event of an emergency, such as unit
malfunction, mechanical failure, power outage, natural disaster, or human error.
I
n an emergency, contact the following people in the order listed:
Role/Responsibility First & Last Name Phone # Alt Phone # E-mail Address
1.
2.
3.
4.
Does the clinic have a generator? If so, where is it?
If your clinic does not have a generator, and/or your vaccine storage unit fails, it might be necessary to transport vaccines to
an alternate storage location (e.g., a local hospital or another provider).Identify an alternate location(s) that has vaccine
storage units and temperature monitoring devices that meet SFDPH Program requirements.
Alternate Vaccine Storage Address & City Phone # Alt Phone # E-mail Address
Location of emergency packing supplies
OTHER USEFUL INFORMATION
Facility Floor Plan: Attach a simple floor diagram identifying the location of key items needed during an emergency: circuit breakers,
flashlights, spare batteries, keys to secured cabinets, backup digital data logger, vaccine storage units, coolers, packing materials, etc.
Page 6
Page 5
Vaccine Management Plan
www.eziz.org
4
Page 7
IMM-1122 (12/17)
Section 4:
Management Plan for Emergency Situations
Use the following guidance for safeguarding vaccines in the event of planned or unplanned power interruptions (e.g., power outages,
weather-related circumstances, building maintenance/repairs, etc.).
CHECKLIST: BEFORE AN EMERGENCY
Proper preparation for emergency situations is essential for protecting the viability of vaccines. Use the following checklist to help
ensure practices are ready for planned or unexpected situations that might impact vaccines.
Step Description
1.
Maintain current emergency contact information for key practice staff.
2.
Maintain current contact information for alternate vaccine storage location(s), including the facility name,
address, and telephone number.
3.
Be familiar with backup power sources for commercial- and pharmacy-grade units.
4.
Stock vaccine packing and transport supplies, including a hard-sided cooler, frozen gel packs, and bubble wrap.
5.
Keep copies of the VFC “Refrigerated Vaccine Transport Log” and “Frozen Vaccine Transport Log” and floor
plans (when available) for easy access during a vaccine-related emergency.
6.
Review (at least annually) the steps key practice staff must take to protect vaccines during short- or long-term
outages.
DURING AN EMERGENCY
Follow these instructions during vaccine-related emergencies in compliance with VFC Program requirements and best practices.
Step Description
1.
Do not open the unit.
2.
Place a “DO NOT OPEN” sign on vaccine storage unit(s) and leave door(s) shut to conserve cold air mass.
3.
Notify the emergency contacts identified on the vaccine management plan’s “Worksheet for Emergency
Vaccine Management”.
4.
Note the time the outage started and storage unit temperatures (CURRENT, MIN and MAX).
5.
Assess the situation to determine the cause of the power failure and estimate the time it will take to restore
power.
6.
If the outage is expected to be longer than 2 hours*:
A. Contact the alternate storage facility to verify they can accept the vaccines.
B. If vaccines will be relocated, refer to “Transporting Vaccines” for instructions.
C. If transport or relocation is not feasible, e.g., alternate location not available or travel conditions are
unsafe, keep vaccine storage units closed and notify the SFDPH IZ Program.
7.
Monitor vaccine storage unit temperatures until power is restored.
8.
Once power has been restored, follow the steps listed in “After an Emergency”.
* Note: Temperatures in commercial-, pharmacy-, and biologic-grade units tend to increase faster during power failures. As a result,
practices using these storage units need to monitor temperatures more frequently and may need to transport vaccines to an alternate
location sooner than two hours.
Adapted by SFDPH,
Vaccine Management Plan
www.eziz.org
5
IMM-1122 (12/17)
Section 4:
Management Plan for Emergency Situations (Continued)
AFTER AN EMERGENCY
Follow these step-by-step instructions after vaccine-related emergencies in compliance with SFDPH Program requirements and
best practices.
Step Description
1.
Verify storage units are functioning properly.
2.
If vaccine storage units are outside the required temperatures ranges, note the time that power was restored
and storage unit temperatures (CURRENT, MIN and MAX).
3.
Once vaccine storage unit temperatures have stabilized, notify the emergency contacts identified on the
vaccine management plan’s “Worksheet for Emergency Vaccine Management”.
4.
If vaccines were transported due to an emergency situation:
A. Follow the same transportation procedures and transfer vaccine back to its original storage unit.
(Refer to the “Transporting Vaccines” for instructions.)
B. If vaccines were kept at the proper temperature during the power outage, notify supervisor that the
vaccines may be used.
5.
If vaccines were maintained at required temperatures:
A. Remove the “DO NOT OPEN” sign from storage unit(s).
B. Notify supervisor that vaccines may be used.
6.
If vaccines were exposed to out-of-range temperatures:
A. Label affected vaccines “Do Not Use”.
B. Document and the excursion using the SFDPH Storage and Handling Incident Summary form and
report it via email (tina.milton@sfdph.org or fax (415-554-2579).
Page 9
Page 8
Vaccine Management Plan
www.eziz.org
6
Adapted by SFDPH, IMM-1122 (12/17)
Section 5: Training Log for Required VFC EZIZ Lessons
List all key practice staff and have them sign and acknowledge that they have completed the required EZIZ lessons.
Staff Name Signature Date
EZIZ Lesson Completion Dates
Storing
Vaccines
Monitoring
Storage Unit
Temperatures
Vaccine Management Plan
www.eziz.org
7
Adapted by SFDPH, IMM-1122 (12/17)
Section 6: Annual Signature Log
Sign and date one signature block each year and when you up update practice-specific information. By signing, staff acknowledge
they have reviewed and are familiar with all the information in the document.
Updates & Comments
Medical Director
Signature/Date
Vaccine Coordinator
Signature/Date
Backup Vaccine Coordinator
Signature/Date
Signature/Date
Staff who Updates VMP
Signature/Date
Additional Staff
Signature/Date
Updates & Comments
Medical Director
Signature/Date
Vaccine Coordinator
Signature/Date
Backup Vaccine Coordinator
Signature/Date
Signature/Date
Staff who Updates VMP
Signature/Date
Additional Staff
Signature/Date
Updates & Comments
Medical Director
Signature/Date
Vaccine Coordinator
Signature/Date
Backup Vaccine Coordinator
Signature/Date
Signature/Date
Staff who Updates VMP
Signature/Date
Additional Staff
Signature/Date
Updates & Comments
Medical Director
Signature/Date
Vaccine Coordinator
Signature/Date
Backup Vaccine Coordinator
Signature/Date
Signature/Date
Staff who Updates VMP
Signature/Date
Additional Staff
Signature/Date
Page 13
Page 10
Additional Staff
Additional Staff
Additional Staff
Additional Staff
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Section 1: Important Contacts (Disease Prevention & Control - San Francisco Department of Public Health)

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Completed 10 January 2021

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