Grocery Pharmacy Immunization Clinic Setup Checklist

Inspection template for setting up an in-store immunization clinic, including vaccine refrigeration verification, anaphylaxis kit readiness, emergency supplies, and clinic area safety checks.

Inspection Details

• Clinic setup date and start time recorded
  Record when the immunization clinic setup inspection was completed.
• Inspector name and role documented
  Enter the name and role/title of the person completing the inspection.
• Clinic area identified and prepared for immunization workflow
  Confirm the designated clinic area is set up and clearly identified for vaccine administration.
• Applicable SOP or clinic setup checklist available on site
  Verify the current local procedure or checklist is available for reference during setup.

Vaccine Refrigerator and Temperature Control

• Refrigerator temperature is within acceptable range
  Measure the vaccine refrigerator temperature at setup.
• Temperature monitoring device is calibrated and in place
  Confirm a calibrated temperature monitoring device is present in the refrigerator or monitoring system is active.
• Temperature logs are current and reviewed
  Verify temperature logs are up to date and show review before clinic use.
• Refrigerator door seals intact and door closes fully
  Check that the refrigerator door seals are intact and the unit closes securely.
• Vaccines are stored with adequate air circulation and not touching the back or sides
  Confirm vaccines are arranged to allow airflow and are not placed against cooling elements or walls.

Anaphylaxis Kit and Emergency Supplies

• Anaphylaxis kit is present and immediately accessible
  Confirm the emergency anaphylaxis kit is on site and reachable without delay.
• Epinephrine auto-injector or emergency epinephrine supply is within expiration date
  Verify epinephrine in the anaphylaxis kit is not expired.
• Anaphylaxis kit contents are complete
  Select the items present in the emergency kit.
• Emergency response instructions are posted or available
  Verify anaphylaxis response steps and emergency contact information are available to staff.

Clinic Area Safety and Workflow

• Patient waiting and vaccination areas are clearly separated
  Confirm the clinic layout supports privacy and safe patient flow.
• Emergency exit routes are unobstructed
  Verify exits and egress paths near the clinic area are clear.
• Hand hygiene supplies are available at point of care
  Confirm hand sanitizer or handwashing access is available for staff use.
• Sharps container is present, mounted or stable, and not overfilled
  Check that a sharps container is available and within safe fill limits.

Staff Readiness and Documentation

• Vaccinating staff are authorized and assigned for the clinic
  Confirm staff assigned to administer vaccines are credentialed and scheduled.
• Emergency contact numbers are available to staff
  Verify local emergency response numbers and internal escalation contacts are accessible.
• Patient screening and consent forms are available
  Confirm required screening and consent documents are ready for use.
• Inspection comments and corrective actions documented
  Record any deficiencies, non-conformances, or corrective actions identified during setup.