Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

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Drug Storage, Labeling, Security

  • Medication Cart

  • Discontinued medications are NOT available for administration *

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  • Medications are properly labeled (e.g., have expiration dates, etc) *

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  • Medication vials are dated when opened, when appropriate *

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  • Medications are locked and secure (including those needing to be destroyed, if required by state regulation)

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  • External medications are separated from internal medications *

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  • Medications are properly protected from light and humidity, and stored at

  • appropriate temperature

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Drug Storage, Labeling, Security

Medication Room

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  • Temperature logs are maintained for medications including vaccines and are in

  • appropriate temperature range

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  • Medications are properly labeled (e.g., have expiration dates, etc) *

  • Mark only one oval

  • Medications are locked and secure (including those needing to be destroyed, if required by state regulation)

  • Mark only one oval

  • Automatic dispensing cabinets are working properly (if applicable) *

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  • Controlled substances are properly and securely stored, per regulation *

Controlled Substances

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  • Controlled substance inventory is reconciled according to facility procedures *

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  • Controlled substance documentation is accurate and complete *

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  • Controlled substances are destroyed in a timely manner, or per regulation as

  • applicable

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