Investigational Product Accountability Log: Subject Record Name of Site: Product Name: Principle Investigator: Manufacturer: Protocol #: Dose Form and Strength: Protocol Title: Dispensing Area: Line Subject ID Subject’s Quantity Dispensed Balance Forward / Recorder’s Date Dose Lot No. No. Number Initials and/or Received Balance Initials 600 Ex. 15Feb2012 ABC 10 mg - 100 tabs JAD 500 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Check if final page of log:
Investigational Product Accountability Log: Subject Record Name of Site: Product Name: Principle Investigator: Manufacturer: Protocol #: Dose Form and Strength: Protocol Title: Dispensing Area: Line No. Date Subject ID Number Subject’s Initials Dose Quantity Dispensed and/or Received Balance Forward / Balance Lot No. Recorder’s Initials Ex. 15Feb2012 ABC 10 mg - 100 tabs 600 500 JAD 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Check if final page of log: