IMMUNIZATION PROGRAM
Checklist for Immunization Program
Components
Immunization programs have many things to consider to ensure safety. This checklist is an overview of the necessary
preparations and considerations. It should be used in conjunction with the online Checklist for Immunization Program
Components (http://www.health.state.mn.us/divs/idepc/immunize/hcp/adults/checklist.html), which contains live links
to suggested resources.
1. Legal Considerations
Program Oversight
Qualified staff person assigned to compile and update policies and procedures on components below
Staff Training
Management of vaccine
Protocols
In accordance with practice boards, signed by a licensed prescriber
Staff are appropriately credentialed to execute protocols
2. Storage and Handling
Vaccine Management Plan
Ordering vaccine
Receiving vaccine
Rotating stock and documenting inventory
Vaccine Storage
Correct equipment
Storage units
Calibrated temperature monitoring device
Monitoring temperatures twice daily
Planning for Vaccine Emergencies
3. Screening and Assessing
Determining Immunization Needs
Obtaining immunization history
Using MIIC for assessment
Routine, catch-up, and risk-based assessment
Plan future needs/follow-up appointments
Minnesota Department of Health – Immunization Program
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CHECKLIST FOR IMMUNIZATION PROGRAM COMPONENTS – PAGE 2
Screening for Contraindications and Precautions
Providing Risk/Benefit Education
Required: Vaccine Information Statements (VIS)
Screening for MnVFC Elegibility
4. Vaccine Administration
Preparing Vaccine
Proper reconstitution technique, diluent, handling
Needle size and safety, route
Patient Safety
Patient positioning/proper holds
Observation after vaccination
Place to sit/lay down if needed
Post-Vaccination Care/Observation
Anaphylaxis protocol signed by licensed prescriber
Equipment for managing a reaction or emergency
Post-vaccination instructions
5. Documentation
Federally required components
Clinic-specific requirements
MIIC
Vaccine Adverse Event Reporting System (VAERS)
Minnesota Department of Health
Immunization Program
PO Box 65975
St. Paul, MN 55164-0975
651-201-5503 or 1-800-657-3970
www.health.state.mn.us/immunize
Minnesota Department of Health – Immunization Program
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