Drug Delivery Quality Assurance Checklist Form
Use this checklist to inspect a drug delivery for product accuracy, packaging condition, storage compliance, documentation completeness, and final quality assurance status.
Delivery and Inspection Details
Delivery Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Delivery Time
*
Hour Minutes
AM
PM
AM/PM Option
Delivery / Reference Number
*
Delivery Location / Site
*
Carrier / Delivery Provider
*
Please Select
DHL
FedEx
UPS
USPS
Local Courier
In-house Delivery
Other
Inspector Name
*
Inspector Role / Title
*
Shipment and Product Verification
Purchase Order / Shipment Reference
*
Supplier or Pharmacy Name
*
Product Name(s) / Product List
*
Dosage Form
*
Please Select
Tablet
Capsule
Injection
Oral Solution
Suspension
Cream
Ointment
Eye Drops
Other
Strength / Concentration
*
Quantity Received
*
Quantity Expected
*
Lot/Batch Number(s)
*
Expiry Date(s)
*
Packaging, Condition, and Storage Checks
Outer packaging condition
*
Intact
Minor damage
Damaged
Missing
Seal integrity
*
Intact
Broken
Not applicable
Tamper evidence observed
*
Yes
No
Labeling accuracy
*
Correct
Partial mismatch
Incorrect
Storage condition on arrival
*
Acceptable
Marginal
Unacceptable
Temperature on arrival (°C)
Temperature log or cold-chain indicator present
*
Yes
No
Visible damage or contamination noted
No visible issues
Package crushed
Leakage observed
Contamination observed
Moisture exposure
Other
Required packaging materials present
*
Ice pack
Insulated container
Temperature logger
Desiccant
None required
Additional packaging, condition, or storage observations
Documentation Review and QA Outcome
Delivery note present
*
Yes
No
Invoice or packing list present
*
Yes
No
Certificate of analysis / quality document present
Yes
No
Not applicable
Discrepancy type(s) observed
Short shipment
Wrong item
Damaged item
Temperature excursion
Expired item
Labeling issue
Documentation missing
None
Discrepancy description
Corrective action required
Please Select
None required
Document review only
Replace missing document
Investigate discrepancy
Quarantine shipment
Return shipment
Escalate to QA
Other
Final QA status
*
Accepted
Accepted with notes
Quarantined
Rejected
Follow-up owner or department
Additional comments
Review supporting documents and record the result.
Submit Checklist
Should be Empty: