Michigan Dept. of Health & Human Services – Division of Immunization 5/19/2023: This form is available at www.michigan.gov/vfc
CHECKLIST FOR VFC SITE VISIT PREPARATION
Depending on facility type and needs, visits may take 3-4 hours. Most providers also have a Quality Improvement Visit
during site visits to review coverage rates and select improvement strategies. To prepare for the VFC portion, utilize
this checklist. For more information, contact your Local Health Department or visit
www.michigan.gov/vfc.
AREA OF PREPARATION
Key staff are available for the site visit (VFC Primary and Backup Coordinator at minimum).
Annual training requirement is fulfilled and documented. For details, see Annual Training.
Review and bookmark/save the online VFC Resource Guide (www.michigan.gov/vfc) and
the
NEW
VFC Provider Manual.
The following documents are available for review:
☐ Annual training documentation: guidance is available here.
☐ Vaccine Management Plan & Emergency Plan: reviewed and signed annually. Its practices align with
CDC, Michigan VFC, and LHD requirements, and are implemented appropriately.
• Templates are available here.
☐ Up-to-date Vaccine Information Statements (VIS). These must be Michigan versions.
• A list of the most current is available here.
☐ “DO NOT DISCONNECT” signs are at outlets & circuit breaker (breaker will be accessed at visit).
• Signs are available here.
☐ 3 months of temperature logs for all units, and any excursion documentation if applicable.
☐ Borrowing Logs: all logs since date of last site visit (logs are available here.)
☐ Certificates of calibration for all data loggers, including at least one backup data logger.
☐ Current versions are posted for: Vaccine Preparation & Administration and Storage & Handling
Staff can explain and define VFC eligibility categories and screening/documentation procedures.
• For specialty providers with modified screening requirements (Hepatitis B Provider, MI-
AVP, etc.), ensure screening according to your program: See section 9 of Provider Manual
VFC staff can explain billing procedures for vaccine and administration fees. Our administration fee
for non-Medicaid VFC-eligible patients is: $
A random chart pull will allow review of at least 10 patient records and vaccine documentation.
Immunization documentation includes: address of clinic, vaccine type, date given, manufacturer,
lot number; publication date of VIS, date VIS provided; and the name and title of vaccinator
All VFC documents are maintained for at least 3 years.
Vaccine storage and handling aligns with CDC and MI VFC requirements (units, data loggers,
vaccine placement, original packaging, etc.).
Vaccine preparation, administration, and inventory practices align with CDC and MI VFC
requirements (stock rotation and separation, vaccines offered, VAERs, etc.).
Circuit breaker will be accessible. If additional power supply protection, this will be provided.
Post-Checklist Provider Notes/To-Do’s:
