INVESTIGATIONAL DEVICE ACCOUNTABILITY LOG Study Title: IRB#: NOTE: Retain a copy of the packing slips for all shipments received and sent. Investigator: DEVICE RECEIPT DEVICE USE DEVICE RETURN / REPAIR / DESTRUCTION Initials of RET=Returned Date Initials of Lot # / Serial or Date Participant # of Device Type / Batch # Comments Device Comments DES=Destroyed Date Initials Reason Comments Rec’d Receiver Model # Used ID Units Dispenser REP=Repaired Version 7.7.15 University of Pittsburgh Education and Compliance Office for Human Subject Research
INVESTIGATIONAL DEVICE ACCOUNTABILITY LOG IRB#: Study Title: Investigator: NOTE: Retain a copy of the packing slips for all shipments received and sent. DEVICE RECEIPT DEVICE USE DEVICE RETURN / REPAIR / DESTRUCTION Date Rec’d Initials of Receiver Lot # / Serial or Model # Device Type / Batch # Comments Date Used Initials of Device Dispenser Participant ID Comments RET=Returned DES=Destroyed REP=Repaired Date Initials # of Units Reason Comments Version 7.7.15 University of Pittsburgh Education and Compliance Office for Human Subject Research
DeviceAccountabilityLog.docx