Instruction Document: Reporting Accidental Loss on DEA Form 41

DEA Form 41 is used to request permission from the DEA to destroy controlled substances. The only time University researchers use Form 41 is after controlled substances have been lost due to accidentally spilling or breaking a container.

**Do not follow the instruction as written on Form 41 as this form is used for other purposes by pharmacists.**

Clean up the spilled controlled substance and discard everything in a laboratory wastebasket, as appropriate in your building.

Obtain a copy of DEA Form 41.

Print a copy and complete the registration information at the top of the form.

On the first line of the form, enter the drug name, concentration and amount lost.

On another line briefly write how the controlled substance was lost and cleaned up.

The person who lost the controlled substance signs and dates on the next line. If there was a witness, have the person sign/date as a witness.

The DEA registrant enters the DEA number and is the last person to sign the form in the upper right corner.

Make a copy of the completed Form 41 for the Unit Registrant's records. Mail to the Minneapolis DEA office.

Be sure to write an entry in your disposition record of the quantity of drug lost and have the witness sign the record.

For disposal of waste controlled substances in a slurry bottle or expired controlled substances, see the instructions on the DEHS website.