VFC Digital Data Logger Re-Calibration Form

Complete the form below to document all new, replacement and any digital data loggers that have been re-calibrated.
If your office is purchasing new digital data loggers, please review the CDC requirements for data loggers that monitor VFC vaccines, by clicking here.

Submit updated DDL calibration information

Date*
MM slash DD slash YYYY
VFC PIN*
Practice Name*
Phone number*
Fax Number*
Completed By:*
Email*
Instructions for Completion:
All VFC Providers are required to document the following details for each Digital Data Logger (DDL) that monitors VFC vaccines. If your practice currently has a DDL with a date of calibration which has either expired or is scheduled to expire soon. (OR) If you are sending your primary DDL out for re-calibration, you should use your back-up DDL to monitor temperatures in your vaccine storage unit until your primary DDL has been re-calibrated. In order to update your ImmuNet profile with your new calibration expiration date(s) please complete the form below.
DDL #1*
Please list the required details for each digital data logger.
Make Model Serial number Calibration expiration date Is this a dual probe device?
Which storage unit is this DDL for?*
DDL #2*
Please list the required details for each digital data logger.
Make Model Serial number Calibration expiration date Is this a dual probe device?
Which storage unit is this DDL for?*
Back up and additional DDLs
Back up DDL*
Please list the required details for each digital data logger.
Make Model Serial number Calibration expiration date Is this a dual probe device?
Add Additional DDLs*
- Yes
- No
Additional DDL #1
Please list the required details for each digital data logger.
Make Model Serial number Calibration expiration date Is this a dual probe device?
Which storage unit is this DDL for?
Additional DDL #2
Please list the required details for each digital data logger.
Make Model Serial number Calibration expiration date Is this a dual probe device?
Which storage unit is this DDL for?
Additional DDL #3
Please list the required details for each digital data logger.
Make Model Serial number Calibration expiration date Is this a dual probe device?
Which storage unit is this DDL for?

Maryland Vaccines for Children Program

Submit updated DDL calibration information

Instructions for Completion:

Back up and additional DDLs

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Make	Model	Serial number	Calibration expiration date	Is this a dual probe device?