Centralized Clinical Trial Monitoring Checklist Form
Complete this form to document centralized monitoring activities and follow-up actions for clinical trial oversight.
Site Name or Identifier
*
Monitoring Visit Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Visit Type
*
Please Select
Routine Monitoring
For Cause
Close-out
Remote Review
Current Monitoring Status
*
Completed
In Progress
Pending Follow-Up
Key Monitoring Areas Reviewed
*
Informed Consent Documentation
Source Data Verification
Investigational Product Accountability
Safety Reporting
Protocol Compliance
Other
Issues Observed (if any)
Severity of Issues Observed
*
None
Minor
Major
Critical
Corrective Actions Planned
Follow-Up Responsibility
*
Please Select
Site Staff
Sponsor Monitor
Data Management
Other
Target Date for Follow-Up (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Checklist
Should be Empty: