Investigational Product Accountability Log
Protocol Title:
Protocol Number:
Site Name/Number:
Principal Investigator:
Sponsor:
Study Drug Name/ID:
Dosage Form/Strength:
Accountability Log
Date
Lot/Batch No.
Received from (shipment info)
Quantity Received
Dispensed to (subject #/ initials)
Quantity Dispensed
Quantity Returned
Quantity Destroyed
Current Balance
Sign/Initial
Comments
Remarks:
Log Completed by (Name/Signature):
Date: