DEA Form 106 Controlled Substance Loss Reporting

Use it when a controlled substance is stolen, significantly lost, or diverted, and you need to document the incident and reporting steps. It is meant for the internal record that supports preliminary notice and DEA Form 106 submission. If the event is only a routine inventory variance with no indication of loss or diversion, this template may be more than you need. Keep the record focused on the facts you can verify.

It is usually completed by the registrant, compliance lead, pharmacy manager, controlled substance officer, or another designated reviewer. The person entering the record should have access to the incident details, inventory records, and any law enforcement information. A second reviewer should confirm the timeline, submission status, and corrective actions before the record is closed. That helps create a cleaner audit trail.

It is event-driven, not scheduled. Complete a new record for each theft, significant loss, or diversion incident, and update it as more facts become available. If your organization has multiple facilities, each incident should be logged separately so the location and registrant details stay accurate. Do not reuse one record for unrelated events.

Include only the fields needed to describe the incident, identify the substance, record the notice timeline, and capture corrective actions. Use precise field types for dates, quantities, and reference numbers, and avoid adding unrelated patient or employee details. Follow data minimization and collect only the PII or incident data you actually need for reporting and review. If a field is optional, keep it optional unless your internal policy requires it.

No. This template is a working record that helps you gather and organize the information needed for the official filing. It can support internal review, but it does not replace the required DEA submission process. Keep the submission reference number and dates in the record so you can show what was filed and when. Treat the template as the intake and tracking layer.

Common mistakes include leaving out the discovery time, mixing up the preliminary notice date with the DEA Form 106 submission date, and entering vague descriptions like "missing stock" without the quantity and package details. Another frequent issue is failing to document whether law enforcement was notified and by whom. People also sometimes skip the root cause and corrective action fields, which weakens the review trail. Clear, factual entries make the record more useful.

Yes. You can add conditional logic for facility type, incident method, or whether law enforcement was involved, so users only see fields that apply. Many organizations also add approval steps, internal case numbers, or links to inventory logs and camera footage. Keep the form short at first and expand only where your process needs more detail. That reduces completion errors and improves usability.

This template can sit alongside inventory management, incident reporting, compliance case management, and document storage workflows. You may want to link it to a police report, internal investigation file, or controlled substance inventory record. If your process supports audit trails, keep the submission dates and reviewer names in the same record. That makes later retrieval and review easier.

Start with one facility or one controlled substance program and confirm who owns each field before expanding. Train staff on what counts as significant loss, when preliminary notice is required, and how to avoid speculative entries. Then standardize the review step so every incident is checked for completeness before submission. A short rollout guide usually prevents inconsistent reporting.