Please resolve the following issues before proceeding
Click on an issue to go directly to the related section of the form.
errors found:
warnings found:
Date notification submitted

Initial information

Notification of lost scheduled substance(s)
Fields marked with * are required

This form may also be used to report discrepancies in records to the Department.

Under what authority were the items originally obtained prior to the incident? *

Licence / Permit number:
What type of premises were the items located at prior to being lost? *
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You may not need to complete this form

Some health services, including aged care services may not need to complete this form. Be aware that you do not have to report an incident involving loss to the Department (i.e. you don’t need to complete this form to report loss) if:

•The lost products were NOT originally obtained via either of the following ways:◦On the authority of a Victorian poisons licence or permit◦On the authority of a registered health practitioner (including a pharmacy (a pharmacist), a medical practitioner, a veterinary practitioner, a nurse practitioner, an authorised midwife, an authorised optometrist or an authorised podiatrist).
AND
•The incident has, or will be, reported to a police officer from Victoria Police.
So, an aged care service that does not hold a poisons permit does not need to complete this form if the incident has been, or will be, reported to a police officer from Victoria Police.

(This is outlined in Sub-regulation 153(2) of the current Victorian Drugs, Poisons and Controlled Substances Regulations).

Confirmed theft or misappropriation?

Has the incident been a result of a definite theft, or has it been confirmed that someone intentionally caused products to go missing (i.e. confirmed misappropriation)?
Notifications may not be needed if items can be accounted for through conducting
When should a lost scheduled substance notification be made, and when should one not be made?

How was it discovered?

How was the incident discovered?
(Select the option that seems most applicable to the situation)
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What type of discrepancy was found?
What location were the products thought to be located at prior to going missing?
Were there any signs of forced entry into the locked storage facility that was part of the premises?
Given that there were signs of forced entry into a storage facility, please ensure that your organisation would not consider the incident to be one of confirmed theft or misappropriation (see the section further above).
Before submitting this report, please ensure that your organisation conducts a very thorough investigation to try to determine why products seemed to disappear from a locked storage facility. (So ensure that all relevant staff are questioned and ensure that all usage and movement records are reviewed). Often the whereabouts of products can be discovered through this process.
Was someone thought to be overseeing the products when they went missing?

Confirm an acceptable investigation has been carried out

Confirm that your organisation has carried out an acceptable investigation to try to determine the cause of the incident, but despite this investigation, your organisation has been unable to determine an acceptable explanation for the incident. •Where an acceptable explanation for the incident has been determined, the explanation should be recorded within the transactions of the relevant product, but the matter need not be reported to the Department. •It would be expected that a reasonable investigation into an incident should not take longer than seven days from the time that the incident is detected.

Likely cause

Even though your organisation may not be sure what the cause of the incident has been, please indicate what your organisation believes would be the most likely cause of the incident. Where more than one factor may have contributed to the incident, please indicate which factor is most likely to be the primary cause.
What were the most likely incorrect record(s) made?
(More than one option may be selected)
Where were the products most likely misplaced?
How would this likely issue best be described?

Level of certainty

Indicate how certain your organisation is that the cause of the incident is what you have indicated in the section above, on a scale of 0 to 99 where: •0 means that your organisation is not sure at all of the cause of the incident •99 means that your organisation is almost completely sure (but not 100% sure) that the incident can be explained by the cause indicated above
(Note that if your organisation is 100% certain of the cause of the incident (i.e. there is undeniable evidence of the cause) and the cause is: •Theft or misappropriation, then you should change the answer you provided to “Yes – Definite theft or misappropriation” in the section further above (entitled "Confirmed theft or misappropriation?")•Anything else, then your organisation may not need to make a report to the Department (i.e. there is complete certainty that product(s) have not been stolen or misappropriated by anyone at all, and there is undeniable evidence the product can be accounted for in another way). However, in this case, your organisation should make a record of the explanation in the records it keeps for the transactions of the relevant product.

Please provide your details (the person completing this form)

After you submit this form, you will automatically be sent a confirmation email with receipt of this submission to the email address you provide above.

Details

Notification of lost scheduled substance(s)
Fields marked with * are required

What was the last address at which the items were located prior to the incident occurring?

When was it discovered that the incident had occurred?

Do you know some, or all of the items that were involved in the incident? *

List all known items that were involved in the incident *
Active ingredient(s) in the item
Units
Strength
per unit
Number of units

Please make the following confirmation *

Theft or misappropriation

Which of the following does your organisation believe would be most likely be responsible for any theft or misappropriation that is relevant to this incident:
(Even if your organisation is unsure of who is responsible, it should complete this question for what it believes is most likely) (More than one option may be selected if more than one person is responsible)

Possible AHPRA reporting

Do you know who is responsible for intentionally causing the item(s) to go missing AND is that person a registered health practitioner?
At this time, can you provide the name of the responsible health practitioner to Drugs and Poisons Regulation (Department of Health)? *
Please provide the following details of the responsible health practitioner

Please make the following confirmation *

Making the above-mentioned report to a police officer is a requirement under Regulation 152 of the current Victorian Drugs, Poisons and Controlled Substances Regulations.

Subsequent actions

Notification of lost scheduled substance(s)
Fields marked with * are required
Please complete this section, even though you have indicated that the discrepancies indicate that there seems to be more product in stock than what there should be. This situation may indicate that products may not have been entered in to stock to begin with (so additional staff education may be required).
Will all staff that regularly work in the area where item(s) went missing be advised of the incident (or have all such staff already been advised of the incident)?
Indicate what changes will be considered (ie: strategies that are not already used) to try to prevent a similar incident in the future *
The staff that carry out such reviews should be separate and independent from the other staff that work in the areas being reviewed. The reviews would include: •Reviewing orders for scheduled substances to be delivered to the organisation to ensure that:◦There has been a legitimate need for scheduled substances to have been ordered; and◦Scheduled substances that have been ordered have, in fact, been received and added to the organisation’s stock.•Reviewing transaction records to ensure there are no discrepancies which may indicate that stock is unaccounted for. It’s possible for the reviewer to detect discrepancies by obtaining separate records of stock that has been delivered to the organisation (ie: request a supply invoice from a supplier) from a particular date, conducting a stock balance check of that stock that is currently being stored, and reviewing the transaction records since the stock was delivered to ensure that the records can at least account for any current amount that is less than what was delivered.
Keeping a running stock holding balance of riskier products (so the holding balance is checked and recorded each time a product line has stock added or removed)
(Note that this must always occur for Schedule 8 substances anyway)
Implementing a system for a period of time in the area where products went missing whereby:
Indicate what staffing changes will be considered to try to prevent a similar incident in the future.
Indicate what changes relating to stock being held will be considered to try to prevent a similar incident in the future.
Indicate what changes relating to the receiving stock will be considered to try to prevent a similar incident in the future.
Indicate what changes relating to the transfer or delivery of stock will be considered to try to prevent a similar incident in the future.
Indicate what changes relating area access will be considered to try to prevent a similar incident in the future.
Indicate what premises security changes will be considered (ie: strategies that are not already used) to try to prevent a similar incident in the future.