Controlled Substance Biennial Inventory Log Form
Record the required biennial inventory details for a controlled substance count, including site, storage location, substance information, quantity on hand, and verification by the completing staff member.
Inventory Event Details
Inventory Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inventory Time
*
Hour Minutes
AM
PM
AM/PM Option
Facility/Site Name
*
Storage Location / Vault / Room Identifier
*
Controlled Substance Inventory Type / Schedule
*
Please Select
Schedule I
Schedule II
Schedule III
Schedule IV
Schedule V
Other
Inventory Reference ID
Controlled Substance Counts
Substance name or product identifier
*
Dosage form and strength/concentration
*
Unit of measure
*
Tablets
Capsules
mL
Grams
Other
Quantity on hand at time of inventory
*
Discrepancy or notes
Completing Staff and Verification
Name of Completing Staff
*
First Name
Last Name
Role/Title
*
Verification Signature
*
Submit Inventory Log
Submit Inventory Log
Should be Empty: