Batch Investigational Product Accountability Log

Protocol #:	________________________________	Investigator name:	__________________________________
IMP:	________________________________	Site ID:	__________________________________
Batch no:	________________________________	IMP dosage form:	__________________________________
Container definition:	________________________________	Starting balance	__________________________________
Dispensing information	Return information	Completed by the monitor
Participant number	Initials	Visit no	Date dispensed	Amount dispensed	Initial	Balance	Date returned	Amount returned	Counted by (Initials)	Amount Counted	Date	Initials	Comments