Ad Viewing Log Form
Log and verify details of advertisement viewing sessions for accurate tracking and reporting.
Viewer Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Date and Time of Viewing
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Viewing (Specify physical location or online platform)
*
Ad Campaign Name or ID
*
Type of Advertisement
*
Please Select
Video
Banner
Audio
Social Media Post
Email
Other
Platform or Channel
*
Please Select
TV
YouTube
Facebook
Instagram
Radio
Website
Other
Estimated Duration of Viewing (in seconds)
*
Did you view the advertisement in full?
*
Yes
No
Rate the effectiveness of the advertisement
1
2
3
4
5
Upload a screenshot or photo as evidence (if available)
Upload a File
Drag and drop files here
Choose a file
Cancel
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Additional Comments or Observations
Submit Log
Should be Empty: