CONTROLLED SUBSTANCE USAGE LOG
1. One log sheet must be completed for each container of Controlled Substance. If the material is converted or diluted, start a new
log form to track that usage; reference the original container’s lot or serial # and original bottle #.
Controlled Substance usage must be tracked on a per dose (use) basis and only by an Authorized User. Record total quantity of
the substance to the nearest metric unit weight/volume or the total number of units finished form.
Controlled Substances Dispensed in Bulk Form must be returned to the DEA Registrant inventory daily.
Lot or Serial #:
Date Returned: *
Unique Bottle Number assigned
Date Remainder was Disposed:
by DEA Registrant*:
Name of Authorized User (print)
*This information is a unique number added to the controlled substance bottle in some labs. This is not required.
**Number of Animals and Species, i.e., (5 mice) or describe other administration.
DEA Registrant Signature:
Instructions: Registrant should maintain completed form in his/her records for at least two years from the date of the last
ORSP – August 2015