Free controlled substance destruction record and joint declaration
Page 1 holds what the regulations ask a destruction record to say: the place, the date, the method, and each product with its controlled substance, strength, form, DIN, containers and units. Patient returns get only the collection container's identifier and the number of containers.
The joint declaration sits under it, with a line for the person who destroyed the stock and one for the witness. Page 2 is a running log, so every destruction can be found and posted to the perpetual log.
What is on it
- Place of destruction, date and method
- Product, controlled substance, strength, form and DIN
- Containers and units, with the reason
- Patient returns: container identifier and number of containers
- Joint declaration: names, signatures and dates
- Page 2: the running destruction log
When you reach for it
- Destroying expired or damaged stock at the pharmacy.
- Sealing a full denaturing container in front of a witness.
- Keeping every destruction in one log, tied to the perpetual log.
How often to count, and how long to keep a sheet, are answered on the count sheets hub. Every sheet prints the Ontario and federal retention rules in its own footer.
More sheets
- All seven sheets in one PDF — When you are setting the whole narcotic book up at once.
- Editable log spreadsheet — When the arithmetic is the part that goes wrong.
- Perpetual inventory log — The ongoing record you keep between counts.
The counting is the easy half
NarcCount works out what you should have from records you already keep. See it worked through on one drug or get the data out of your dispensing system.