Vaccines for Children Program and COVID-19 Vaccination Program Forms, Job Aids and Charts

The following forms, charts and handouts maybe downloaded and used by you and your staff to complete necessary Vaccines for Children (VFC) and COVID-19 program requirements.

VFC Forms and Guides

• VFC Provider Agreement (PDF)
• Eligibility Screening Form (PDF)
• Accessing the Center for Disease Control Training Modules Instructions (PDF)
• VFC Vaccine Ordering and Inventory Management (PDF)
• How to Report Spoiled and Expired Vaccine (PDF)
• Vaccine Storage and Thermometer Module Guide (PDF)
• Vaccine Inventory Management Borrowing & Replacement Guide (PDF)

VFC and COVID-19 Job Aids

Vaccine Management Job Aids

• VFC Vaccine Management Plan (PDF)
• Vaccine Management Job Aid (PDF)
• How to Do a Physical Inventory Job Aid (PDF)
• Safeguard Your Power Supply Job Aid (PDF)
• Vaccine Handling Guidelines
• Vaccine Handling Tips (PDF)

Vaccine Refrigerator Setup and Storage Job Aid

• NYC VFC Vaccine Storage Unit Thermometer Guide (PDF)
• Vaccine Refrigerator Setup (PDF)
• Storing VFC Vaccine in a Stand-Alone Refrigerator Unit (PDF)
• Storing VFC Vaccine in a Pharmaceutical Grade Refrigerator and Freezer Unit (PDF)
• Storing COVID-19 Vaccine in a Stand-Alone Refrigerator Unit (PDF)
• Storing COVID-19 Vaccine in a Pharmaceutical Grade Refrigerator and Freezer Unit (PDF)

Vaccine Freezer Setup and Storage Job Aid

• Vaccine Freezer Setup (PDF)
• Storing VFC Vaccine in a Freezer (PDF)
• Storing VFC Vaccine in a Pharmaceutical Grade Refrigerator and Freezer Unit (PDF)
• Storing COVID-19 Vaccine in an Ultra-Cold Freezer Unit (PDF)
• Safeguard Your Power Supply Job Aid (PDF)
• Vaccine Handling Tips (PDF)

Vaccine Temperature Monitoring Charts

• NYC Certificate of Calibration Checklist for Thermometers (PDF)
• Recording Refrigerator Temperatures (PDF)
• Recording Freezer Temperatures (PDF)
• Celsius Refrigerator and Freezer Temperature Logs
  • Freezer Temperature Log (PDF)
  • Refrigerator Temperature Log (PDF)
  • Ultra-Cold Freezer Temperature Log (PDF)
• Fahrenheit Refrigerator and Freezer Temperature Logs
  • Freezer Temperature Log (PDF)
  • Refrigerator Temperature Log (PDF)
  • Ultra-Cold Freezer Temperature Log (PDF)
• Temperature Excursion Incident Report
• Temperature Conversion Chart (PDF) 

Vaccine Documentation and Policy Information

• Policy for Multi-dose Vials of Vaccine 
• Vaccine Administrative Record 
• Vaccine Contraindications (PDF)
• Vaccine Replacement Policy (PDF)