HealthRX.com · Printable dose-error record
Syringe, needle and vial-label match check
Copy the concentration from the pharmacy label and the mark your pharmacist confirmed, note the syringe and needle you were given, and tick the checks before drawing. A near-miss log at the bottom gives you something concrete to report. It records what your prescriber and pharmacist set; it does not calculate a dose.
From the label and the pharmacist
Drug name exactly as on the vial label
Concentration printed on the labelamount per mL, copied word for word
Amount the prescriber wrote
Syringe mark the pharmacist confirmedunits or mL, and on which syringe size
Syringe and needle suppliedcapacity in mL, gauge, needle length in mm
Before drawing
- The syringe in my hand is the type the pharmacist confirmed
- The label concentration matches what I copied above
- New needle and syringe, wrapping and cap intact
- Sharps container within reach
Reference points
- On a standard 1 mL U-100 insulin syringe, each small notch is 1 unit of U-100 insulin.[1]
- With a 90-degree insertion, needles of 4 to 5 mm reach the fat layer with minimal risk of hitting muscle in virtually all adults.[2]
- Do not use the same needle and syringe more than once; discard any with broken wrapping or a missing cap.[3]
- Put used needles in a sharps container immediately, and follow local rules once it is about 3/4 full.[4]
Near misses or errors
Write what happened even if no harm resulted, and tell your pharmacist or prescriber.
| Date | What happened | How it was noticed | Who you told |
|---|---|---|---|
Sources for the facts on this sheet
- U.S. National Library of Medicine. Giving an insulin injection: MedlinePlus Medical Encyclopedia. Accessed 2026-10-18. https://medlineplus.gov/ency/patientinstructions/000660.htm
- Gibney MA, Arce CH, Byron KJ, Hirsch LJ. Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations. Curr Med Res Opin 2010. PMID 20429833. https://pubmed.ncbi.nlm.nih.gov/20429833/
- U.S. National Library of Medicine. Subcutaneous (SQ) injections: MedlinePlus Medical Encyclopedia. Accessed 2026-10-18. https://medlineplus.gov/ency/patientinstructions/000430.htm
- U.S. Food and Drug Administration. Best Way to Get Rid of Used Needles and Other Sharps. Accessed 2026-10-18. https://www.fda.gov/medical-devices/safely-using-sharps-needles-and-syringes-home-work-and-travel/best-way-get-rid-used-needles-and-other-sharps
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.