Vaccine Breach Form

If the LCD on your TagAlert is displaying an arrow towards the X and displaying a number between 1 and 4 next to the heart, immediately isolate the vaccines and store between 1 and 8 Degrees.

Please complete the below form and one of our cold chain specialists will be in contact shortly.

Please ensure your vaccines are in the fridge with the vaccine monitor until we confirm the extent of the breach.

Business Name (*)

Account Number (*)

First Name (*)

Last Name (*)

Email (*)

Phone Number (*)

Invoice Number (*)

Consignment Number

Were Parcels Delivered Damaged (*)

Time Taken from Delivery to Unpacking into Fridge (*)

Monitor Type: Please click on the monitor that came with your delivery.

Sensitech TagAlert

SpotSee Freeze/Warm Indicator

Alarms: Please click the alarm/s that are displayed on your TagAlert. If your TagAlert screen is blank please submit this form without clicking an alarm.

Alarm 1

Alarm 2

Alarm 3

Alarm 4

SpotSee Freeze/Warm Indicator:Please click the breach indications that are displaying on your SpotSee Freeze/Warm Indicator

Freeze Indicator: Freeze indicator dot has become as dark or darker than the reference dot

Yes

Warm Indicator:Showing any colour in the breach window such as light pink, pink or red.

None

Brief

Moderate

Prolonged

Additional Comments

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Vaccine Breach Form