Sample Investigational Device Accountability Log Protocol #: ____________________ PI: ____________________ DEVICE RECEIPT DEVICE USE DEVICE RETURN/REPAIR/DESTRUCTION RET=Returned Initials of Initials of Lot #/ Serial or Device Type / Batch Date # of Date Rec’d Comments Device Participant ID Comments Date Initials Auth # Reason Comments Receiver Model # # Used Units Dispenser REP=Repaired
Sample Investigational Device Accountability Log Protocol #: ____________________ PI: ____________________ 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 REP=Repaired Date Initials Auth # # of Units Reason Comments
CRSC-E506_TEMPLATE_Source%20Document%20Binder%20-%20Devices_FINAL_5-21-14.docx