9c Site:__________________ Test Article Accountability Record Protocol #: Protocol: Product (test article/placebo/diluent/product name): Packaging: Manufacturer: number: Storage Temperature: Name/Strength/Dosage Form: (vial/bottle/carton/kit) Received by: Date of Receipt (mm/dd/yy) Number received Expiration (vials/containers/ ( if known): kits): Date PID or Vial No. Quantity Received/ Comments Balance Date of Physical mm/dd/yy Dispensed Dispensed Dispensed Forward Inventory (for) By End Balance→ (take forward to next page Page ______ of ________ A new form should be started for each new shipment of product.
Site:__________________ 9c Test Article Accountability Record Protocol #: Protocol: Product (test article/placebo/diluent/product name): Packaging: (vial/bottle/carton/kit) Manufacturer: number: Storage Temperature: Name/Strength/Dosage Form: Received by: Date of Receipt (mm/dd/yy) Number received (vials/containers/ kits): Expiration ( if known): Date mm/dd/yy PID or Vial No. Dispensed (for) Quantity Dispensed Received/ Dispensed By Comments Balance Forward Date of Physical Inventory End Balance→ (take forward to next page Page ______ of ________ A new form should be started for each new shipment of product.