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This form should be used by immunisation service providers to report all wastage of government-funded vaccines as it occurs within their practice/clinic.

Vaccine wastage report form
Please provide as much information as possible in the fields below.

Indicate the cause of vaccine wastage by selecting an option from the drop-down menu.

Indicate the number and type of vaccines wasted and destroyed by placing a number in the field adjacent to each relevant vaccine brand.

On completion, click the submit button to send this report to the Communicable Disease Control Directorate.
Fields marked with an asterisk (*) are required

Please note:  if this wastage is the result of a cold chain breach where vaccines have been exposed to temperatures outside the recommended 2-8 degree C range, please contact your Regional Immunisation Coordinator (RIC) for advice before disposing of any vaccine.

For queries about vaccine efficacy following a cold chain breach please contact your Regional Immunisation Coordinator.

For queries related to vaccine orders or reporting vaccine wastage via this form please contact the vaccine orders team at the Communicable Disease Control Directorate on ph. 9388 4863 or vaccineorders@health.wa.gov.au

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