Controlled Drug Inspection Form
Use this form to record and review a controlled drug inspection, including inventory checks, storage/security observations, discrepancies, and final outcome.
Inspection Details
Inspection Date
*
-
Month
-
Day
Year
Date
Inspection Time
*
Hour Minutes
AM
PM
AM/PM Option
Inspection Type
*
Routine
Follow-up
Complaint-based
Transfer Verification
Other
Inspection Reference Number
*
Purpose / Trigger for Inspection
*
Inspector and Facility Information
Inspector Name or Team Name
*
Inspector Role / Title
*
Facility / Site Name
*
Department / Unit / Ward / Room
*
Facility Contact Person
*
Controlled Drug Inventory Verification
Controlled Drug Items
*
Storage and Security Check
Locked storage status
*
Compliant
Non-compliant
Not applicable
Access control status
*
Compliant
Non-compliant
Not applicable
Temperature control status
Compliant
Non-compliant
Not applicable
Segregation of expired or returned stock
Compliant
Non-compliant
Not applicable
Observed issues
Security breach or storage concern details
Discrepancies and Corrective Actions
Were any discrepancies found?
*
Yes
No
Discrepancy details
Immediate action taken
Corrective action required
Responsible person or department
Target completion date
-
Month
-
Day
Year
Date
Inspection Outcome
Final Inspection Result
*
Passed
Passed with Findings
Failed
Pending Recheck
Inspector Comments / Recommendations
Follow-Up Required
*
Yes
No
Follow-Up Date and Time
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Inspector Acknowledgment
*
Submit Inspection
Submit Inspection
Should be Empty: