Clinical Trial Sponsor Monitoring Checklist Form
Complete this checklist to document sponsor-side clinical trial monitoring visits and outcomes.
Monitoring Visit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Site Name or Number
*
Site Location (City, State/Country)
*
Monitor Name
*
Visit Type
*
Site Initiation
Interim Monitoring
Close-out
For-cause Visit
Other
Monitoring Status
*
Completed
Partially Completed
Not Completed
Checklist Outcomes (select all that apply)
*
No issues identified
Protocol deviations observed
Incomplete source documentation
Investigational product accountability issues
Informed consent documentation issues
Other
Describe Any Issues Identified
Follow-up Actions Required
Date of Next Planned Monitoring Visit
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Checklist
Should be Empty: