Counterfeit Product Monitoring Log Form
Log details of suspected counterfeit product incidents for monitoring and action.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Product Name or Type
*
Brand/Manufacturer
*
Suspected Counterfeit Indicators
*
Unusual packaging
Spelling errors or poor print
Missing or altered serial numbers
Low product quality
Price significantly lower than usual
Other
Source of Suspected Product
*
Please Select
Retail store
Online marketplace
Wholesale distributor
Direct shipment
Other
Location of Incident (City, State/Region, Country)
*
Description of Incident and Product Details
*
Upload Evidence (photos, documents, etc.)
Upload a File
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of
Business Impact Assessment
*
Low
Moderate
High
Follow-up Action Taken or Recommended
*
Submit Log
Should be Empty: