Laserfiche WebLink
2016 <br />WASHINGTON STATE DEPARTMENT OF HEALTH <br />OFFICE OF IMMUNIZA rlON AND CHILD PROFILE <br />Organization Name: KITTITAS VALLEY HEALTHCARE <br />Clinic/Facility Name: KITTITAS COUNTY PUBLIC HEALTH <br />PIN: 163000 <br />FROZEN VACCINE PROVIDER <br />RECERTIFICATION FORM <br />Can freezer maintain an average temperature between SF (-1SC) and -S8F (-SOC)?: ® yes <br />or 0 no <br />Does freezer have a separate, insulated door: ® yes or 0 no <br />What type of temperature measuring device is used in freezer? <br />Freezer 1: Stand Alone Freezer -Digital Data Logger <br />Freezer 2 : <br />Freezer 3: <br />Freezer 4: <br />Freezer 5 : <br />Freezer 6: <br />Freezer 7: <br />Freezer 8: <br />[Z] By signing this document I certify that appropriate storage is in place for frozen <br />Full name of Provider with prescriptive authority": MARK LARSON <br />Date: ___________________ _