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Run: Pharmacy Temperature Excursion Response Log

Log a pharmacy refrigerator temperature excursion, identify affected products, and document pharmacist disposition and follow-up in one audit-ready record.

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Inspection Details

Date and time excursion was discovered critical (required)

Storage unit identification critical (required)

Record the refrigerator, freezer, or cold storage unit ID/location.

Inspector or reporter name critical (required)

Temperature monitoring device verified critical (required)

Confirm the device or data logger used to identify the excursion was checked for accuracy and status.

Yes No N/A

Excursion Event Details

Observed temperature at start of excursion critical (required)

Observed temperature at end of excursion critical (required)

Excursion duration critical (required)

Temperature range outside approved limits critical (required)

Document the acceptable storage range and the actual out-of-range condition.

Excursion was contained and storage unit secured critical (required)

Confirm the affected unit was secured to prevent further product exposure.

Yes No N/A

Affected Product Identification

Affected product names or NDCs critical (required)

List all potentially impacted medications, vaccines, or biologics.

Lot numbers recorded critical (required)

Document lot numbers for each affected product when available.

Expiration dates recorded

Document expiration dates for affected products when available.

Estimated quantity affected critical (required)

Products segregated pending disposition critical (required)

Confirm affected items were quarantined or otherwise segregated from usable stock.

Yes No N/A

Pharmacist Review and Disposition

Pharmacist reviewed excursion critical (required)

Yes No N/A

Disposition decision critical (required)

Note (optional)

Pharmacist rationale documented critical (required)

Summarize the basis for the disposition decision, including reference to product stability information or SOP if applicable.

Notification completed to required parties

Select all parties notified regarding the excursion.

Corrective Actions and Follow-Up

Root cause identified critical (required)

Document the likely cause of the excursion, such as door left ajar, equipment failure, or power interruption.

Corrective action taken critical (required)

Describe immediate corrective actions taken to restore compliant storage conditions and prevent recurrence.

Preventive action assigned

Document any follow-up action, maintenance request, staff retraining, or SOP update.

Follow-up verification scheduled

Record the date and time for post-incident verification or maintenance follow-up.

Inspector Attestation

Inspector signature critical (required)

Inspection completed critical (required)

Yes No N/A

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