DHA Form 177,
Potentially Compromised Temperature Sensitive Medical Product Worksheet

Step One:

Activate Site/Clinic Emergency Response Plan

1. 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.)
2. Label exposed TSMP as "DO NOT USE," and place them in a separate container apart from other products in the storage unit.
3. 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.
4. Notify your local leadership of the potential loss.
5. 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

1. 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.
2. 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.
3. 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.
4. Click the "Submit by email" button, ensure the "Desktop Email Application" button is selected and click "OK".
5. 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.
6. For vaccines only, include your IHS's email address (if known) on the "To" line when the message opens up.
7. 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.
8. Standby for further instructions from DLA-TSM and/or USAMMA-DOC. They will provide disposition for your TSMP.
9. 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.