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Temperature Deviation Form

1) This document is a temperature deviation report form used to report any temperature deviations during the transport of Novo Nordisk products. It requests information about the shipment, details of the temperature problem, and temperature readings from a recorder. 2) The reporter is asked to provide their contact information and details of the affected products, including the quantity and batch numbers. 3) Instructions are given for reporting the temperature readings based on intervals and to attach the temperature recorder chart.

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375 views2 pages

Temperature Deviation Form

1) This document is a temperature deviation report form used to report any temperature deviations during the transport of Novo Nordisk products. It requests information about the shipment, details of the temperature problem, and temperature readings from a recorder. 2) The reporter is asked to provide their contact information and details of the affected products, including the quantity and batch numbers. 3) Instructions are given for reporting the temperature readings based on intervals and to attach the temperature recorder chart.

Uploaded by

erikaoktavianipurba
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Handling, Storing, Packaging, Protecting and Delivering Novo Nordisk products 1 of 2

Appendix 3: Transport temperature deviation report form (2


pages)
Please send this form with documentation (see section 3) to DFPQS by e-mail to
[email protected] or fax +45 4442 7430.

Please use BLOCK CAPITALS if you fill in by hand.


Information on shipment
Invoice no: Local ref no:
Date and time of removing temperature / /201 (day/month/year)
recorders and placing the products in cold ____:_____ (hours:min) (24 hrs clock)
storage:
Date you discovered deviation: / /201 (day/month/year)
Does Novo Nordisk own the products? Yes No
Have the products been put in quarantine? Yes No
What is the total number of temperature
recorders in the shipment?

Description and evaluation of temperature problem during transport

Continue on separate sheet if necessary.


Reporter
Name: Initials:
Job title: Address:
Company:
E-mail address: City:
Phone no: Country:
Contact person in affiliate or representative office (name and initials):

Products affected by deviation (please attach invoice and packing list)


Temperature recorder no Product name Quantity Batch no

TempTracer summary report attached Yes No If no, please fill in

Process: Edition: Internal number: Document number:


11.0 - 040747
Handling, Storing, Packaging, Protecting and Delivering Novo Nordisk products 2 of 2

temperature readings

Temperature readings
Celsius Celsius hours:min
-20 to -5 : Shipment:
-5 to -3 : Storage:
-3 to 0 : Temperature recorder start date and time:
0 to +2 : / /201 ; :
(day/month/year) (hours:min) (24 hrs clock)
+2 to +8 :
+8 to +15 : Temperature recorder stop date and time:
+15 to +25 : / /201 ; :
(day/month/year) (hours:min) (24 hrs clock)
+25 to +30 :
+30 to +35 :
+35 to +40 :
Above +40 :

If a temperature reading, for example +8C, belongs to two intervals, use the lower
temperature interval, for example from +2C to +8C.

Please attach temperature recorder chart.

Filled in by (signature and date): / /201 (day/month/year)

Comments

Process: Edition: Internal number: Document number:


11.0 - 040747

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