Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Enter the name of your surgery in the specified field. Ensure this reflects the official name used for your practice.
3. Input the UD account number, which is a 7-digit number starting with 300. This ensures your submission is correctly linked to your account.
4. Provide your contact name and contact number. This information helps facilitate communication regarding the submission.
5. Select the product from the provided list. You may need to check the relevant vaccine being stored or involved in the excursion.
6. Indicate the quantity of the vaccine that was affected during the incident.
7. Document the batch number of the vaccine to allow for traceability in case of further investigations.
8. Record the last recorded fridge temperature, including the date and time, ensuring that it falls within the acceptable range of +2 °C to +8 °C.
9. Specify the duration during which the vaccines were outside the recommended temperature range.
10. Document the maximum or minimum temperature recorded during the breach, marking this appropriately.
11. Indicate whether the vaccines had been involved in prior temperature excursions by selecting 'Yes' or 'No'.
12. Once all fields are filled accurately, save your changes before submitting the form. You can then download or print the completed form for your records, or share it with the necessary recipients.

Complete the IE HSE Cold Chain/Fridge Breakdown/Power Failure Form online today to ensure vaccine safety.