Pharmacy Access Log Form
Please complete this form to log and track all pharmacy access visits. Ensure all information is accurate for compliance and security.
Visitor Full Name
*
First Name
Last Name
Visitor Organization/Company
Date and Time of Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Purpose of Visit
*
Please Select
Medication Delivery
Inspection/Audit
Maintenance
Vendor Visit
Other
Areas Accessed
*
Storage Room
Dispensing Area
Controlled Substances Cabinet
Receiving Area
Other
Was the visitor escorted?
*
Yes
No
Name of Escorting Staff (if applicable)
Staff Member Verifying Access
*
Visitor Contact Information (Phone or Email)
Additional Comments or Notes
Submit Entry
Should be Empty: