Page 1 of ____
Controlled Substance Use Log
Complete a log sheet for each container of Controlled Substance. If the material is diluted, start a new log form to track usage of
each new container and use the original container's log or serial # and original bottle # assigned by the laboratory.
Lot or Serial Number:
Unique Container Number:
Date/time disposed (if applicable)
When content has been consumed, forward a copy of the completed controlled substance use log to EHS, 262 Alexander Street
Name of Person
in Vial (ml,
Protocols, Species and/or identification of
Material drawn up for dosing that was not used or could not be fully extracted; e.g., syringe hub loss.
*Medication that has been drawn up and not administered should be labeled as DEA Waste – Do Not Use, and secured in the lab's
controlled substance lock box until it can be properly disposed of by Environmental Health and Safety.
For EHS use: Vial removed from DEA Inventory on ___________ by _____________________________.