Temperature log must be submitted daily. Once submitted, the date and time will be recorded automatically.

Submission Time Stamp:

Completed by:*

First Name Last Name

Location:*

Refrigerator Temperature*

Degrees in Fahrenheit

Are there any multi dose medications present?

NO YES

If yes, how many multi dose medications are present?

Medication #1

Medication Name LOT#

Has this medication #1 been opened?

NO YES

If medication #1 is open:

Open date: Expiration date (28 days after date opened): Expiration date (28 days after date opened):

Medication #2

Medication Name LOT#

Has this medication #2 been opened?

NO YES

If medication #2 is open:

Open date: Expiration date (28 days after date opened): Expiration date (28 days after date opened):

Medication #3

Medication Name LOT#

Has this medication #3 been opened?

NO YES

If medication #3 is open:

Open date: Expiration date (28 days after date opened): Expiration date (28 days after date opened):

Comments (if any):

If outside of the acceptable temp range, please write actual temperature here

Youth Home Nurse Daily Temperature Log