Vaccine Storage Audit Form
Complete this Vaccine Storage Audit Form to assess storage conditions and operational readiness.
Facility Name
*
Date of Audit
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Auditor Name
*
Storage Unit Temperature
*
Is the temperature log up to date?
*
Yes
No
Condition of Storage Unit
*
Please Select
Excellent
Good
Needs Maintenance
Is the alarm system functional?
*
Yes
No
Is a power backup available and operational?
*
Yes
No
Are vaccines organized and labeled correctly?
*
Yes
No
Notes / Corrective Actions Taken
Submit Audit
Should be Empty: