Immunisation program

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Forms and reporting

Vaccine order forms

Use this form when ordering all NIP vaccines for your clinic.

Use this form when ordering all diphtheria outbreak vaccines for your clinic.

Vaccine wastage form online

Use this form to report all vaccine wastage.

In the event of vaccine wastage due to a Cold Chain Breach, do not discard the vaccines until advised by CDC. Call the Immunisation Program on 08 8922 8315 during business hours to report a Cold Chain Breach.

Adverse event following immunisation form

Adverse events following immunisation refers to any untoward medical occurrence that follows immunisation, whether it is expected or unexpected and regardless of whether it is triggered by the vaccine or coincidentally occurs following its administration.

Refer to the Australian Immunisation Handbook for specific definitions and advice on adverse events following immunisation (AEFI’s) or call the Immunisation Program on 08 8922 8315 during business hours.

To report an AEFI on line or to access a hard copy, fill in these forms:

Vaccination recording form

If you are a vaccine provider and do not currently record immunisations electronically, complete this form for people of any age who have received a vaccination.

Email the completed form to immunisationntir.health@nt.gov.au or fax the form to NT Immunisation on 08 8922 8897.

Rabies/lyssavirus post-exposure prophylaxis form

Use this form for all cases requiring rabies/lyssavirus post-exposure prophylaxis.

This includes giving rabies immunoglobulin (HRIG) and/or rabies vaccine.

Email completed form to immunisationprogramnt.health@nt.gov.au.

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