CHE
Best Practices
FOR
Vaccination Clinics Held at
Satellite, Temporary, or Off-Site Locations
OVERVIEW OF THIS DOCUMENT
This checklist is a step-by-step guide to help clinic coordinators/supervisors overseeing vaccination clinics held at satellite, temporary, or
off-site locations follow Centers for Disease Control and Prevention (CDC) guidelines and best practices for vaccine shipment, transport,
storage, handling, preparation, administration, and documentation. It should be used in any non-traditional vaccination clinic setting, including
but not limited to: workplaces, community centers, schools, makeshift clinics in remote areas, and even medical facilities when vaccination
occurs in the public areas or classrooms. Temporary clinics also include mass vaccination events, and vaccination clinics held during
pandemic preparedness exercises. This checklist outlines CDC guidelines and best practices that are essential for patient safety and vaccine
effectiveness.
A clinic coordinator/supervisor at the site should complete, sign, and date this checklist EACH TIME a vaccination
clinic is held
. To meet accountability and quality assurance standards, all signed checklists should be kept on file by the company that
provided clinic staffing.
INSTRUCTIONS
1.
A staff member who will be at the vaccination clinic should be designated as the clinic coordinator/supervisor. (This individual will be responsible for
completing the steps below and will be referred to as “you” in these instructions.)
2.
Review this checklist during the planning stage of the vaccination clinic—well in advance of the date(s) when the clinic will be held. This checklist
includes sections to be completed before, during, and after the clinic.
3. Critical guidelines for patient safety and vaccine effectiveness are identified by the stop sign icon: . If you check “NO” in ONE OR MORE
answer boxes that contain a , DO NOT move forward with the clinic. Follow your organization’s protocols and/or contact your state or
local health department for guidance BEFORE proceeding with the clinic. Do not administer any vaccine until you have confirmed that it is
acceptable to move forward with the clinic.
4.
Contact your organization and/or health department if you have any concerns about whether vaccine was transported, stored, handled, or
administered correctly, concerns about whether patients’ personal information was protected appropriately, or concerns about other responses that
you have marked as “NO” on rows that do not have the
.
5.
This checklist should be used in conjunction with CDC’s Vaccine Storage and Handling Toolkit:
www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf. For information about specific vaccines, consult the vaccine
manufacturer’s package insert.
6.
This checklist applies ONLY to vaccines stored at REFRIGERATED temperatures
(i.e., between 2–8° Celsius or 36–46° Fahrenheit).
7.
Sign and date the checklist upon completion of the clinic or completion of your shift (whichever comes first). (If more than one clinic coordinator/
supervisor is responsible for different aspects of the clinic, you should complete only the section(s) for which you were responsible.)
8.
Attach the staff sign-in sheet (with shift times and date) to the checklist (or checklists if more than one clinic supervisor is overseeing different
shifts), and submit the checklist(s) to your organization to be kept on file for accountability.
Name and credentials of clinic coordinator/supervisor:
Name of facility where clinic was held:
Address where clinic was held (street, city, state):
Time and date of vaccination clinic shift (the portion you oversaw):
Time and date when form was completed:
Signature of clinic coordinator/supervisor:
This document was created by the Influenza Work Group of the National Adult and Influenza Immunization Summit.
Version 6 (Updated February 8, 2019)
CS249275-A