{"content":[{"text":"Effective \n Date: \n 04/26/2018","bbox":{"left":0.560196,"top":0.089242,"width":0.09835300000000002,"height":0.055713}},{"text":"Form Number: \n EHS_SOP350_FORM005","bbox":{"left":0.685294,"top":0.089242,"width":0.22678399999999999,"height":0.038289000000000004}},{"text":"TITLE: \n Controlled Substance Inspection Self-Audit \n Checklist","bbox":{"left":0.097059,"top":0.15803,"width":0.372902,"height":0.055591}},{"text":"Responsible Authority: \n HSC Safety Coordinator","bbox":{"left":0.560196,"top":0.15803,"width":0.22331599999999996,"height":0.03828899999999999}},{"text":"Instructions: The form can be completed online but it must be printed and signed. \n Completed and signed forms must be kept in the Controlled Substances \n Manual. A completed copy must be submitted to the Health Sciences \n Campus Safety Coordinator. \n Annual Inspection Follow-up Inspection \n   Inspection Date:________","bbox":{"left":0.119216,"top":0.253788,"width":0.7542340000000001,"height":0.10258999999999996}},{"text":"Registrant Name: ______________________","bbox":{"left":0.119216,"top":0.367197,"width":0.39796,"height":0.020818000000000003}},{"text":"Registration #: ___________________","bbox":{"left":0.533726,"top":0.367197,"width":0.339136,"height":0.020818000000000003}},{"text":"Department: ___________ Building: ______ Room Storage Location: ___________ \n Yes No N/A Checklist Items \n 1. Are DEA Registration and FL Exemption Letter in the CS Manual? \n    \n Are they current? \n 2. Are Employee Questionnaire on file for all Authorized Users? \n    List of \n users:_______________________________________________ \n 3. Are CS inventories up to date, and details of the use have been \n    \n documented? \n 4. CS inventory on hand matches the quantity stated in the Biennial \n    \n Inventory Log? \n    5. Is recordkeeping maintained for the last 2 years only? \n    6. Are order and receipt records available for each purchase? \n 7. DEA Form 222 are available for all Schedule I and II Drugs? Are \n    \n the forms secured? \n 8. Does the registrant have an SOP for the use of CS and for \n    \n detecting loss or diversion? \n 9. Schedule I & II records and storage are separate from Schedule \n    \n III-V, and other prescription drugs? \n    10. Are disposal records and DEA 41 Form (if applicable) available? \n 11. Are prepared solutions of CS labeled, locked and secured? Is a \n    \n separate log sheet used? \n    12. Are all CS logs and receipt forms maintained?","bbox":{"left":0.119216,"top":0.399015,"width":0.75149,"height":0.47566699999999995}},{"text":"Page 1 of 2 \n EHS_SOP350_FORM005 \n REV0 All Printed Documents are Uncontrolled","bbox":{"left":0.117647,"top":0.899924,"width":0.554238,"height":0.05566700000000002}},{"text":"04/26/2018","bbox":{"left":0.784118,"top":0.934773,"width":0.09835300000000002,"height":0.020818000000000003}}],"images_bbox":[{"left":0.119118,"top":0.098169,"width":0.284314,"height":0.054924}],"images_bbox_not_text_overlap":[{"left":0.119118,"top":0.098169,"width":0.284314,"height":0.054924}]}