Retail Pharmacy Compliance Audit Checklist Form
Complete this checklist to assess compliance operations at the retail pharmacy. Please provide accurate details and thorough responses for each section.
Audit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Store/Site Name or ID
*
Store Location (City, State)
*
Auditor Name
*
First Name
Last Name
Audit Scope
*
Please Select
Full Compliance Audit
Inventory Management
Prescription Handling
Controlled Substances
Other
Compliance Checklist
*
Rows
Compliant
Partially Compliant
Non-Compliant
Not Applicable
Valid licenses displayed
1
2
3
4
Staff training records up-to-date
5
6
7
8
Inventory records accurate
9
10
11
12
Prescription records complete
13
14
15
16
Storage of controlled substances secure
17
18
19
20
Severity of Issues Identified
*
None
1
2
3
4
Critical
5
1 is None, 5 is Critical
Description of Issues or Non-Compliance (if any)
Corrective Actions Recommended
Auditor Signature (Type Your Name)
*
Submit Audit
Should be Empty: