Forms

• Vaccine Storage Troubleshooting Record
• Temperature Log for Refrigerator
• Temperature Log for Freezer
• PDF [2MB]
  Vaccine Administration Record PDF [2MB]
  912e
• PDF [205KB]
  Request for Medical Exemption from Vaccinations PDF [205KB]
  Form 139-M
• PDF [164KB]
  Request for Religious Exemption from Vaccinations PDF [164KB]
  Form 139-R
• PDF [62KB]
  Non-Viable Vaccine Returns PDF [62KB]
  Providers: Should this vaccine be returned or disposed? Check this document.
• Vaccine Return Form
  Form 131. Please complete this Vaccine Return Form for any vaccine eligible for return by vaccine providers.
• PDF [170KB]
  Vaccine Borrowing Report PDF [170KB]
  Form 1122