Cytotoxic Drug Safety Assessment
Please complete this form to assess cytotoxic drug safety practices in your area.
Assessor's Full Name
*
First Name
Last Name
Assessor's Role or Position
*
Department or Location
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Types of Cytotoxic Drugs Handled (select all that apply)
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Alkylating agents
Antimetabolites
Plant alkaloids
Anthracyclines
Other
Which safety measures are currently in place? (select all that apply)
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Use of personal protective equipment (PPE)
Spill management protocols
Proper drug storage and labeling
Staff training on cytotoxic drug handling
Waste disposal procedures
Other
Have there been any recent incidents or exposures involving cytotoxic drugs?
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Yes
No
Additional Comments or Observations
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