Cold Chain Failure Incident Report

Incident Details

Date of Incident

Time of Incident

Location

Reported By

Description of Incident

Equipment Information

Equipment Type

Equipment ID/Serial

Temperature Range Observed (°C)

Products Affected

List of Products / Batches

Immediate Actions Taken

Root Cause Analysis (if identified)

Follow-up / Preventive Actions

Names & Signatures

Reported By

Supervisor/Manager