Vaccine Management Forms

• Reporting Nonviable MDH Vaccine to MIIC (PDF)
  How to use the MDH Nonviable Vaccine Form in MIIC to report nonviable or lost MDH vaccine. If doses are part of a storage and handling incident, contact MDH at 651-201-5522 before reporting in MIIC.
• MDH Vaccine Transfer Record (PDF)
  Form for transferring MDH vaccine to another site in order to prevent vaccine waste.
• VFC Vaccine Borrowing Report (PDF)
  Borrowing occurs when a provider borrows vaccine from MnVFC stock to administer to a patient not eligible for the program, or when a provider borrows vaccine from private stock to use on MnVFC-eligible patients.
• Storage and Handling Mishap Log (PDF)
  Document storage and handling incidents and actions taken.
• Storage and Handling Mishap Checklist (PDF)
  Use this checklist when a storage and handling mishap has occurred.
• Worksheet for Developing an Emergency Plan for Managing Vaccine (PDF)
  Fillable PDF of the worksheet included in the MnVFC Policies and Procedures Manuals. You can find your site's manual on Required Reports and Trainings.
• MDH Vaccine Restitution Appeal Form (PDF)
  Form to file an appeal regarding the waste of the MDH vaccine.