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STUDY DRUG/DEVICE SHIPMENT RECEIPT LOG
Principal Investigator______________________________________________
Clinical Research Coordinator_______________________________________
Protocol Name and/or Number______________________________________
Name of Study Drug or Study Device__________________________________
Date
Shipment
Received
Shipment # from
Packing Slip
Study Drug/Device
Lot #
and/or
Expiration Date
# of Boxes or Kits
per Lot #
# of Bottles, Vials,
Inhalers, or
Devices per Box or
Kit
Condition of Study Drug/Device Shipment
(Intact/Damaged)
Receiver’s
Initials
Washington University in St. Louis
1/10/08
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