Checklist template

Medication room and sample storage for clinics

A ready-to-use checklist with 117 items in 6 sections, covering Access, Storage, Refrigeration, Samples, Expired items, Logs. Use it as-is in InspectLoop, or adapt it to your own standards in minutes.

  • 6 Sections
  • 117 Items
  • 100 Yes / No checks
  • 6 Scored ratings
  • 130 Points

Use this template How audits work

1. Access 18 items

  1. The medication room door was found locked on arrival Yes / No 1 pt
  2. The door closes and locks by itself behind a person leaving Yes / No 1 pt
  3. A written list names the employees authorized to enter the medication room Yes / No 1 pt
  4. The access list was reviewed within the last 12 months Yes / No 1 pt
  5. Keys or badge access of employees who left the clinic have been withdrawn Yes / No 1 pt
  6. Medication keys are carried by an authorized employee, not left in a drawer or hung on a hook Yes / No 1 pt
  7. Medication keys are handed over or locked in a key safe at the end of the day Yes / No 1 pt
  8. Door codes are not written on or near the door Yes / No 1 pt
  9. Controlled substances are held in a locked cabinet inside the locked room Yes / No 1 pt
  10. The controlled substance cabinet key is kept separate from the room key Yes / No 1 pt
  11. Vendor representatives and maintenance workers enter the medication room only when escorted Yes / No 1 pt
  12. No patient or visitor can reach the medication room without passing a staffed area Yes / No 1 pt
  13. Needles and syringes in the room are in a locked cabinet or drawer Yes / No 1 pt
  14. A medication refrigerator outside the locked room has its own lock Yes / No 1 pt
  15. Medication cabinets outside the room (procedure room, nursing station) were found locked Yes / No 1 pt
  16. The emergency medication kit is sealed with a numbered tamper seal Yes / No 1 pt
  17. Employees on the medication room access list Number
  18. Control of access to medications Rating
    • Locked, with keys held only by authorized staff 5 pts
    • Locked, with keys loosely controlled 3 pts
    • Found unlocked or accessible to others 1 pt

2. Storage 22 items

  1. Medications are stored in their original labeled containers Yes / No 1 pt
  2. Oral, injectable and topical medications are on separate shelves or in separate bins Yes / No 1 pt
  3. Medications for external use are stored apart from those for internal use Yes / No 1 pt
  4. Look-alike and sound-alike medications are separated or flagged with a warning label Yes / No 1 pt
  5. High-alert medications named in company policy carry a high-alert label Yes / No 1 pt
  6. Different strengths of the same medication are in separately labeled bins Yes / No 1 pt
  7. Bin labels show the medication name and strength Yes / No 1 pt
  8. Opened multi-dose vials carry the date opened or the discard date Yes / No 1 pt
  9. No multi-dose vial is past the discard period set by company policy Yes / No 1 pt
  10. No opened single-dose vial or ampule is kept for reuse Yes / No 1 pt
  11. No pre-drawn syringes are stored unlabeled Yes / No 1 pt
  12. Light-sensitive medications are kept in their carton or an amber container Yes / No 1 pt
  13. Disinfectants, test reagents and cleaning products are not stored on medication shelves Yes / No 1 pt
  14. Medications are stored off the floor Yes / No 1 pt
  15. The preparation counter is clean and clear of clutter Yes / No 1 pt
  16. The preparation counter is outside the splash zone of the sink, or protected by a splash guard Yes / No 1 pt
  17. No food, drink or personal belongings are in the medication room Yes / No 1 pt
  18. A room thermometer is in the medication room Yes / No 1 pt
  19. The room temperature is within 68°F to 77°F (20°C to 25°C), or the range on the product labels Yes / No 1 pt
  20. A current drug reference is available to staff at the preparation area Yes / No 1 pt
  21. Medication room temperature at the time of the visit (°F or °C) Number
  22. Organization of medication storage Rating
    • Separated, labeled and uncluttered 5 pts
    • Mostly organized, some unlabeled or mixed bins 3 pts
    • Medications mixed or unlabeled 1 pt

3. Refrigeration 24 items

  1. Medications and vaccines are kept in a refrigerator used for nothing else Yes / No 1 pt
  2. No food, drink or specimens are in the medication refrigerator Yes / No 1 pt
  3. The refrigerator is a purpose-built or stand-alone unit, not a dormitory-style unit with an internal freezer compartment Yes / No 1 pt
  4. The refrigerator reads between 36°F and 46°F (2°C and 8°C) Yes / No 1 pt
  5. The freezer holding frozen vaccines, where the clinic has one, reads between -58°F and 5°F (-50°C and -15°C) Yes / No 1 pt
  6. A digital data logger with a buffered probe monitors the refrigerator Yes / No 1 pt
  7. The data logger calibration certificate is within date Yes / No 1 pt
  8. The probe sits in the center of the unit, among the product Yes / No 1 pt
  9. Vaccines are kept in their original boxes Yes / No 1 pt
  10. No vaccine is stored in the door, in drawers or against the back wall Yes / No 1 pt
  11. Space is left between boxes for air to circulate Yes / No 1 pt
  12. Water bottles fill unused door and bottom space to steady the temperature, unless the unit's manufacturer advises against it Yes / No 1 pt
  13. Each vaccine type has a labeled position Yes / No 1 pt
  14. Vaccines supplied through a public program are separated from privately purchased vaccines Yes / No 1 pt
  15. The plug carries a "do not unplug" label Yes / No 1 pt
  16. The circuit breaker for the refrigerator is labeled Yes / No 1 pt
  17. The temperature alarm sounds or sends an alert when tested Yes / No 1 pt
  18. The written plan for a temperature excursion or power failure is posted on the unit Yes / No 1 pt
  19. The employee asked could describe the first steps when the temperature is out of range Yes / No 1 pt
  20. A transport cooler and conditioned ice packs are available for moving vaccines in an emergency Yes / No 1 pt
  21. Medication refrigerator temperature at the time of the visit (°F or °C) Number
  22. Minimum temperature recorded by the data logger since the last reset (°F or °C) Number
  23. Maximum temperature recorded by the data logger since the last reset (°F or °C) Number
  24. Cold storage of medications and vaccines Rating
    • In range, monitored and correctly loaded 5 pts
    • In range with monitoring or loading gaps 3 pts
    • Out of range or unmonitored 1 pt

4. Samples 17 items

  1. Sample medications are kept in a locked cabinet Yes / No 1 pt
  2. Only licensed clinicians or employees designated by policy take samples from the cabinet Yes / No 1 pt
  3. Samples are arranged by medication name Yes / No 1 pt
  4. Different strengths of the same sample are kept in separate bins Yes / No 1 pt
  5. No controlled substance samples are held Yes / No 1 pt
  6. Each sample given to a patient is entered in a dispensing log Yes / No 1 pt
  7. The dispensing log shows the patient, the medication, the strength, the quantity and the lot number Yes / No 1 pt
  8. The dispensing log shows the provider who ordered the sample Yes / No 1 pt
  9. A sample given to a patient is labeled with the patient's name and the directions for use, as local regulation or company policy requires Yes / No 1 pt
  10. The sample given is recorded in the patient's medication list, in 3 log entries traced to the record Yes / No 1 pt
  11. Patients receive the printed medication information with the sample Yes / No 1 pt
  12. Samples are handed over in the manufacturer's sealed package Yes / No 1 pt
  13. Refrigerated samples are kept in the medication refrigerator, not in a staff refrigerator Yes / No 1 pt
  14. No samples were found in exam rooms, desks or providers' offices Yes / No 1 pt
  15. The lot numbers in the dispensing log allow patients to be identified if a sample is recalled Yes / No 1 pt
  16. Sample dispensing log entries reviewed Number
  17. Dispensing of sample medications Rating
    • Every sample logged and labeled for the patient 5 pts
    • Logged but not always labeled 3 pts
    • Handed out without a log 1 pt

5. Expired items 17 items

  1. Every medication storage location is checked for expiry monthly Yes / No 1 pt
  2. Medications expiring within the next month are marked or pulled forward for first use Yes / No 1 pt
  3. No expired medication was found among 20 items sampled in the medication room Yes / No 1 pt
  4. No expired vaccine was found in the refrigerator Yes / No 1 pt
  5. No expired item was found in the emergency medication kit Yes / No 1 pt
  6. The emergency kit list shows the earliest expiry date among its contents Yes / No 1 pt
  7. Expired medications are removed to a container marked "expired, do not use" Yes / No 1 pt
  8. The expired medication container is kept locked and apart from usable stock Yes / No 1 pt
  9. Expired medications leave the clinic through a reverse distributor or a pharmaceutical waste service Yes / No 1 pt
  10. No medications are discarded in the regular trash, the sink or the sharps container, unless the waste procedure directs it Yes / No 1 pt
  11. Expired vaccines are reported and returned as the supplying program requires Yes / No 1 pt
  12. Vaccines within 3 months of expiry that the clinic will not use are offered to another clinic or reported to the supplying program Yes / No 1 pt
  13. Recall notices filed in the last 12 months show the stock was checked on the day the notice arrived Yes / No 1 pt
  14. Partly used vials found without an opening date are discarded Yes / No 1 pt
  15. Expired medications found among 20 items sampled Number
  16. Date of the last monthly expiry check of the medication room Date
  17. Removal of expired medications Rating
    • None found, monthly checks recorded 5 pts
    • Isolated expired item found 3 pts
    • Expired items found in several locations 1 pt

6. Logs 19 items

  1. The refrigerator temperature is recorded each clinic day at the frequency set by company policy or the supplying vaccine program Yes / No 1 pt
  2. The temperature log has no missing entries in the last 30 days Yes / No 1 pt
  3. The minimum and maximum temperatures are recorded at the start of each clinic day Yes / No 1 pt
  4. Data logger records are downloaded and reviewed on the schedule set by company policy Yes / No 1 pt
  5. Each out-of-range reading on the log has a written note of the action taken Yes / No 1 pt
  6. Each delivery of medications and vaccines is recorded on the day it arrives with the lot number and expiry date Yes / No 1 pt
  7. The controlled substance count, where the clinic holds any, is signed by two employees at the frequency set by company policy Yes / No 1 pt
  8. Each temperature excursion in the last 12 months has a record of the advice obtained from the manufacturer or the supplying program Yes / No 1 pt
  9. The emergency medication kit seal number is recorded at each check and matched the seal found during the visit Yes / No 1 pt
  10. Each dose administered from clinic stock is recorded in the patient record with the lot number, in 3 doses traced Yes / No 1 pt
  11. The vaccine inventory record matched the doses in the refrigerator for 3 vaccines counted Yes / No 1 pt
  12. The monthly expiry check record lists each location checked (medication room, refrigerator, emergency kit, sample cabinet) Yes / No 1 pt
  13. The disposal record lists each medication sent for destruction Yes / No 1 pt
  14. The clinic manager or lead nurse initials the logs monthly Yes / No 1 pt
  15. Logs are kept for the period set by company policy Yes / No 1 pt
  16. Missing temperature log entries in the last 30 days Number
  17. Name of the nurse or employee responsible for the medication room Short text
  18. Overall control of the medication room Rating
    • Locked, in range, in date and fully logged 5 pts
    • Secure and in date with gaps in the logs 3 pts
    • Unsecured, out of range or expired stock found 1 pt
  19. Corrective actions required Comments

About this template

This checklist is part of the InspectLoop template library. Yes / No checks score 1 point when met; ratings score the points shown for each option. The overall score is the percentage of points earned, with N/A answers excluded. In InspectLoop you can add photos, assign corrective actions, require sign-off and compare results across sites.

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