Workplace Naloxone Distribution & Use Log
Tracking information about distribution and use of naloxone is crucial to ensuring a continual fresh supply of the drug and monitoring the effectiveness of your program. Here’s a template log you can adapt to track this data.
Workplace Naloxone Distribution & Use Log
Instructions: To be completed by the workplace Naloxone Response Coordinator.
| Number & Types of Kits Prescribed | Date Prescription Written | Date Naloxone Received | Date Naloxone Used | Where Naloxone Used | Staffer who Administered Naloxone |
|---|---|---|---|---|---|