Controlled Substance Waste Log Form
Please complete all sections to accurately record a controlled substance disposal event.
Date of Waste Event
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Waste Event
*
Hour Minutes
AM
PM
AM/PM Option
Waste Location
*
Item/Medication Name
*
Dosage/Strength
*
Quantity Disposed
*
Waste Category
*
Please Select
Expired
Partially Used
Damaged
Contaminated
Other
Method of Disposal
*
Please Select
Incineration
Chemical Deactivation
Return to Manufacturer
Other
Witness/Approver Name
*
Comments/Notes
Submit Log Entry
Should be Empty: