Investigational Destruction Log

Protocol #:	________________________________	Investigator name:	__________________________________
Site ID:	__________________________________
IMP name	Treatment code	Date received	Lot/batch no.	Expiry date	Quantity Received	Quantity Destroyed	Quantity Retained	QC (initial)
Packed	Unpacked	Packed	Unpacked	Packed	Unpacked
Used	Unused	Used	Unused	Used	Unused

Completed by	Designation	Signature	Date	Comment
Received by	Designation	Signature	Date	Comment