Participant Investigational Product Accountability Log

Protocol #:	________________________________	Investigator name:	__________________________________
Participant #:	________________________________	Site ID:	__________________________________
Participant initials:	________________________________
Container definition:	________________________________
Dispensing information	Return information	Completed by the monitor
Investigational product	Batch number	Visit #	Date dispensed	Amount dispensed	Initials	Date returned	Amount returned	Counted by	Amount counted	Date	Initials	Comments