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MBL Controlled Substances Policy – April 2019
APPENDIX E
CONTROLLED SUBSTANCES USAGE LOG
Expiration Date:
Building:
Lot/Serial Number:
Strength:
Unique Vial # Assigned by Authorized Individual:
Room:
Amount in Container:
Form: Powder
Tablet
Injectable Elixer
Date Disposed/Empty:
INSTRUCTIONS
1. Due to their potential for abuse, Controlled Substances are subject to extensive licensing,
registration, storage, security, use, disposal, and inventory requirements.
2. FILL OUT THIS FORM UPON RECEIPT OF THE CONTROLLED SUBSTANCE.
3. One Usage Log sheet must be completed for each container/vial of Controlled Substance.
4. Controlled Substance Usage MUST BE TRACKED on a per dose (use) basis and only by the
Responsible Researcher or an Authorized Individual.
5. All Schedule ll-V Controlled Substances, including their diluted forms, must be kept locked in
the storage cabinet except for the actual time required for Responsible Researcher or
Authorized Individual to remove, legitimately work with and return the Controlled Substances.
6. Controlled Substance Usage Logs must be maintained at all times in the locked cabinet
together with the Controlled Substances.
7. The Responsible Researcher must surrender any unused, unwanted or expired Controlled
Substance(s), including diluted forms, to the Laboratory Research Safety Manager or MBL
Veterinarian (Vet@mbl.edu
) for proper disposal.
8. Failure to follow these guidelines is a serious violation of the IS Drug Enforcement
Administration (DEA) Controlled Substance Act (21 CFR 1300) and the Massachusetts
Department of Public Health, Drug Control Program regulations (105 CMR 700.000).
Signature of Responsible Researcher: Date: .
MBL Attending Veterinarian: Date: .
Name of Responsible Researcher:
Location Where Drugs are Stored
Name of Controlled Substance:
