Pharmacy Controlled Substances Compliance Checklist Form
Complete this form to document your pharmacy's compliance with controlled substances handling procedures.
Date of Compliance Review
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reviewer Full Name
*
First Name
Last Name
Are all required controlled substance logs up to date?
*
Yes
No
Not Applicable
Is storage of controlled substances secure and compliant?
*
Yes
No
Not Applicable
Was a complete inventory count performed?
*
Yes
No
Were any inventory discrepancies identified?
*
Yes
No
Is access to controlled substances limited to authorized personnel?
*
Yes
No
Have any incidents or losses involving controlled substances occurred since the last review?
*
Yes
No
If discrepancies or incidents were identified, briefly describe actions taken.
Additional Reviewer Notes
Submit Compliance Checklist
Should be Empty: