SafetyNet Daily Agent Location Form

Daily Agent Work Site Photo Submission Form
Date*

MonthDayYear
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Distributor Number*
Distributor Name*
Agent Name*
Agent Phone Number*

Area CodePhone Number
Agent Email*
Worksite Photo*
Worksite and tent (when applicable) with all approved SafetyNet marketing materials on display (table covers/skirts, banners, and/or yard signs).
Agent Photo*
Agent in approved SafetyNet apparel, holding the information sheet with agent name and current date.
Work Table Photo*
Work table with all required documents, including a phone and top-up card.
This form must be submitted before the end of business day. If compliance cannot identify you in your pictures, and/or your photos are unclear, you will not get credit for the site audit. Failure to comply with this policy could result in the loss of your SafetyNet ordering credentials.

**NOTICE: PLEASE WAIT UNTIL YOU RECEIVE THE SUBMISSION SENT PAGE AFTER CLICKING SUBMIT BEFORE CLOSING YOUR BROWSER. BY NOT WAITING FOR THE CONFIRMATION PAGE, YOUR PHOTOS MAY NOT HAVE UPLOADED PROPERLY, THEREFORE NOT SUBMITTED.**
Should be Empty: