DHA Form 177,
Potentially Compromised Temperature Sensitive Medical Product Worksheet
Step One:
Activate Site/Clinic Emergency Response Plan
- Do not leave TSMP in non-functioning storage unit. Immediately move the TSMP to a working storage unit at proper temperature (refrigerator: 2-8°C/36-46°F, freezer: below -15°C/5°F,
ultra-cold freezer: below -80°C/-112°F.)
- Label exposed TSMP as "DO NOT USE," and place them in a separate container apart from other products in the storage unit.
- DO NOT destroy, discard or use TSMP until released by:
- Defense Logistics Agency Troop Support Medical (DLA-TSM) for all vaccines (other than those covered by USAMMA-DOC below)/and all other TSMP.
- U.S. Army Medical Materiel Agency Distribution Operations Center (USAMMA-DOC) for anthrax, smallpox or adenovirus.
- Notify your local leadership of the potential loss.
- For incidents that involve vaccines, contact your Defense Health Agency Immunization Healthcare Specialist (IHS) for assistance with reporting the potential loss.
Step Two:
Complete Potentially Compromised TSMP Worksheet
- Complete ALL required information on the PC-TSMP worksheet (see top of page), this will reduce the possibility of delays in receiving disposition for your products.
- Save document as "PC-TSMP_enter clinic name and location_enter current date" using the following example: PC-TSMP_NBHC Key West FL_1 APR 20.
- For vaccines only, when possible, send completed worksheet along with copies of your temperature logs to your IHS for review to confirm all information is appropriately documented.
- Click the "Submit by email" button, ensure the "Desktop Email Application" button is selected and click "OK".
- Attach temperature logs/data and click the send button; it will forward completed worksheet directly to the USAMMA-DOC and DLA-TSM mailboxes: DSCPColdchain@dla.mil, paacoldchainteam@dla.mil, and usarmy.detrick.usamma.mbx.doc@army.mil.
- For vaccines only, include your IHS's email address (if known) on the "To" line when the message opens up.
- If the "Submit by email" button does not work at your location, add all the above email addresses to the "To" line, attach temperature logs/data, and click the send button.
- Standby for further instructions from DLA-TSM and/or USAMMA-DOC. They will provide disposition for your TSMP.
- Contact DLA-TSM, USAMMA-DOC and/or your IHS (vaccines only) if disposition has not been received within 48 hours of submitting the completed worksheet:
USAMMA-DOC/DLA-TSM Contact Information
- DLA-TSM Cold Chain Team: 215-737-5537/5365, DSN: 444-5537/5365, or for URGENT after-hours issues only: 267-738-2854. Email: DSCPColdchain@dla.mil, paacoldchainteam@dla.mil.
- USAMMA DOC: 301-619-4318/3017, after hours: 301-676-1184/0808.
NOTE: If your product is not listed in the drop-down menu on page 4, manually enter the product information to include the brand name, NDC/part number, manufacturer and the cost per dose.
* TSMP collectively refers to: vaccines, some pharmaceuticals, temperature sensitive laboratory supplies, and other temperature sensitive medical items.
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