Pottawattamie County, Iowa

Pottawattamie County Court House
227 South 6th Street
Council Bluffs, IA 51501

Office Hours:
8:00 A.M. to 4:30 P.M. Monday through Friday

Telephone:
Office: 712.328.5777
Office, Secondary: 712.328.5778
Emergency: 911
Fax: 712.328.4843

Emergency Management Agency

Pottawattamie County EMA Logo Pottawattamie County EMS Association
PHARMACY INSPECTION FORM

Submit (1) form for each drug box in your possessions. Make sure to indicate ALS or BLS as well as the box number. Inspections are required monthly for each box and are due no later than the 15th day of each month. (Example, January's pharmacy inspection is due by 1/15/xx)

EMS Service Name
Inspector Name
Inspection Month Year
Drug Box Type	Drug Box Number
Security Tag Number	Is the Drug Box secure?
1st Expiration Date:	Medication Expiring:

Succinylcholine Inspection (if applicable)	Not Applicable
Security Tag Number	Expires
Refrigerated In
Temperature Control Log (should be kept between 40/45F)	Week 1 Date Temp in F
	Week 2 Date Temp in F
	Week 3 Date Temp in F
	Week 4 Date Temp in F

By submitting this Inspection Form I verify that the identified drug box has been inspeccted per pharmacy control policies and procedures.

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Mission Statement

To provide the highest quality government possible to the citizens of Pottawattamie County, Iowa, and other governmental entities in the most efficient and cost effective manner possible. To encourage economic development, enhance our tax base and provide higher quality jobs for our citizens.