C&R Manual

FY2020 C&R Manual.pdf

National Electronic Injury Surveillance System (NEISS) and Follow-up Activities for Product Related Injuries

C&R Manual

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Criteria and Rationales
for Field-Initiated In-Depth Investigations

FY 2020
FOR OFFICIAL USE ONLY
UNAUTHORIZED DISCLOSURE PROHIBITED
NOT FOR USE OUTSIDE CPSC
U.S. Consumer Product Safety Commission
Epidemiology, Division of Data Systems (EPDS)

Criteria and Rationales for Field-Initiated In-Depth Investigations FY 2020

TABLE OF CONTENTS
Purpose ............................................................................................................................................................................................ 1
Fire-Related Hazards ..................................................................................................................................................................... 2
Fires and Thermal Burns, General (BUNN01) ............................................................................................................................. 2
Mattresses and Bedding (BUNN12) ............................................................................................................................................. 3
Upholstered Furniture (BUNN25) ................................................................................................................................................ 4
Children’s Wearing Apparel (BUNN11) ...................................................................................................................................... 5
Candles (or Candle Accessories) (BUNN41) ............................................................................................................................... 6
Fireworks Devices (CARM02) ..................................................................................................................................................... 7
Multi-Purpose Lighters (CARM11) ............................................................................................................................................. 8
LP and NG Gas Systems (BUNN39)............................................................................................................................................ 9
High-Energy Density Rechargeable Battery Fires (BUNN04) ................................................................................................... 10
Electrical and Mechanical Hazards ............................................................................................................................................. 11
Electrical Hazards, General (ELNN01) ...................................................................................................................................... 11
Power Equipment, General (TLNN01)....................................................................................................................................... 12
Chain Saws (TLNN15) ............................................................................................................................................................... 13
Automatic Garage Door Operators (CARM10) .......................................................................................................................... 14
Glass in Doors, Storm Doors, Patio Doors, and Tub & Shower Doors and Enclosures (CARM05) .......................................... 15
Children’s Products ...................................................................................................................................................................... 16
Toys (TYNN01) ......................................................................................................................................................................... 16
Nursery Equipment (TYNN31) .................................................................................................................................................. 17
Playground Equipment (TYNN32)............................................................................................................................................. 18
Children’s Products, General (TYNN05) ................................................................................................................................... 19
Childhood Pool/Spa & Fatal Submersions/Drownings (TYNN26) ............................................................................................ 20
Pool and Spa Entrapments (TYNN26) ....................................................................................................................................... 21
Infant Bathing Product Fatal Submersions/Drownings (TYNN26) ............................................................................................ 22
Infant Fatal Suffocation (TYNN06) ........................................................................................................................................... 23
Childhood Fatalities Involving Instability or Tip-over of Televisions, Furniture, and Appliances (TYNN40) .......................... 25
Childhood Injuries and Fatalities Involving Corded Window Coverings (TYNN45) ................................................................ 26
Chemical Hazards ......................................................................................................................................................................... 27
Chemical Hazards, General (CHNN01) ..................................................................................................................................... 27
Battery Ingestions (CHNN11) .................................................................................................................................................... 28
Poison Prevention Packaging (PPPA) (CHNN08)...................................................................................................................... 29
Carbon Monoxide, General (STNN25) ...................................................................................................................................... 30
Carbon Monoxide Poisoning From Generators and Engine Powered Consumer Products (STNN36)....................................... 31
Carbon Monoxide Death Certificates (STNN34) ....................................................................................................................... 32
Sports and Recreation .................................................................................................................................................................. 33
All-Terrain Vehicle (ATV) & Utility Vehicle (UTV) Deaths (TYNN09) .................................................................................. 33
Sports-Related Deaths and Serious Injuries (TYNN33) ............................................................................................................. 34
Sports Helmet Project (TYNN34) .............................................................................................................................................. 35
Emerging Hazards ........................................................................................................................................................................ 36
Emerging Hazards, General (HANN01)..................................................................................................................................... 36
Nano and Emerging Materials (HANN02) ................................................................................................................................. 37
Wearable Technology Products (HANN02) ............................................................................................................................... 38

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Criteria and Rationales for Field-Initiated
In-Depth Investigations

FY 2020
Purpose
The purpose of the Criteria and Rationales for Field-Initiated In-Depth Investigations (C&R)
is to:
1. Identify certain cases that field staff should assign for in-depth investigation.
2. Provide an explanation of why certain cases should be assigned.
3. Indicate the Investigation Guidelines to be followed during these investigations.
The Investigation Guidelines for each product area are periodically updated and are available in
the Integrated Field System (IFS).
If there are any questions before or during an investigation, the field investigator should contact
the person(s) at headquarters listed in the C&R as points-of-contact for the specific product area.
The investigator should note on the contacts page of the investigation report (Exhibit 1), when a
conversation with an analyst resulted in a change in the investigation requirements.
Because the C&R is only updated/printed on an annual basis (October 1 each year), investigators
making field assignments based on the C&R should confirm that all current appropriate
headquarters staff –both Compliance and non-Compliance – are included in the distribution of
the completed IDI.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

Fires and Thermal Burns, General (BUNN01)
CATEGORY ID: BUNN01
CATID Owner: David Miller

EPHA Analyst:
Project/Program Lead:
Backup contact:
Compliance contacts:

David Miller, EPHA, 301-504-7323, dmiller@cpsc.gov
Rik Khanna, EXHR, 301-987-2508, rkhanna@cpsc.gov
Jennifer Timian, CRE, 301-504-7503, JTimian@cpsc.gov
Blake Rose, CDI, 301-504-7613, brose@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Headquarters will assign fire or explosion incidents involving fatalities or injuries that are not covered by other
categories of the Criteria and Rationales. Telephone or on-site investigations may be requested for high-visibility
cases.
Incidents involving children and portable gasoline containers are being evaluated by the compliance officer in
accordance with the “Children’s Gasoline Burn Prevention Act” of 2008. Any questions on such incidents should be
directed to the Compliance Contact.
Rationale for Obtaining Investigations
Investigations will support the CPSC’s Strategic Plan for 2018 - 2022 to fulfill our mission to promote injury
prevention, to raise public awareness of product risks, and to act quickly when a risk is detected from consumer
product fire hazards. Fire is the third leading cause of deaths in the home (Home Safety Council, 2004). It is a
leading cause of accidental home deaths for children under 5 years old (Centers for Disease Control and Prevention,
2017). Investigations will also be used to monitor the effectiveness of current voluntary standards and to promote
new standards recommended by the Commission staff.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

Mattresses and Bedding (BUNN12)
CATEGORY ID: BUNN12
CATID Lead: David Miller

Includes mattress pads, futon mattresses, adult mattresses, children’s mattresses, waterbeds (with “mattress-like”
bladders), and air mattresses that contain upholstery material between the ticking and the mattress core.
Appropriate Guidelines:

Mattresses/Bedding – Appendix 15
Smoke Detectors/Alarms – Appendix 129

EPHA Analyst:
Project/Program Lead:
Compliance contact:

David Miller, EPHA, 301-504-7323, dmiller@cpsc.gov
Allyson Tenney, LSE, 301-987-2769, atenney@cpsc.gov
Justin Jirgl, CRE, 301-504-7814, jjirgl@cpsc.gov
Troy Whitfield, CRE, 301-504-7548, TWhitfield@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Cases will usually be assigned from Headquarters. Field may also initiate investigations upon notifying the analyst
at Headquarters. Cases of interest are ones where a mattress or bedding was possibly the first item ignited in a fire,
and the fire resulted in at least one civilian death or injury. Fires reported to CPSC by fire departments are
considered the best source of fire incidents. If the mattress and/or bedding items are still available, conduct an onsite investigation and photograph the products; otherwise conduct a telephone investigation. Be sure to determine
and report whether the mattress involved was a "futon mattress" or a conventional mattress. If possible, determine
whether the mattress was a pre- or post-open-flame standard mattress.
Rationale for Obtaining Investigations
Fires in mattresses and bedding were of sufficient concern in the early 1970s to justify the issuance of a mandatory
standard intended to address cigarette ignition. Still, as recently as 2016, there remained an estimated 250 lives lost
due to mattress and bedding fires ignited by smoking materials and an additional 110 deaths occurred a result of
open-flame and other ignition sources. In January 2006, CPSC issued a final flammability rule for mattress sets to
reduce the severity of mattress fires and to make mattresses less flammable. This rule took effect in July 2007.
CPSC is still interested in fires involving the ignition of mattresses and bedding to gather information that can help
in work on addressing casualties resulting from the flammability of bedclothes.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

Upholstered Furniture (BUNN25)
CATEGORY ID: BUNN25
CATID Owner: David Miller

Appropriate Guidelines:

Upholstered Furniture – Appendix 19
Smoke Detectors/Alarms – Appendix 129

EPHA Analyst:
Backup contact:
Compliance contact:

David Miller, EPHA, 301-504-7323, dmiller@cpsc.gov
Andrew Lock, LSE, 301-987-2059, alock@cpsc.gov
Justin Jirgl, CRE, 301-504-7814, JJirgl@cpsc.gov

ATTENTION: We are no longer assigning Upholstered Furniture IDIs at this time.
Criteria for Assigning Non-NEISS Investigations
Upholstered furniture fires caused by any heat source with at least one civilian casualty are of interest. Cases will
usually be assigned from Headquarters. Field may also initiate investigations upon notifying the Headquarters
analyst. Conduct a telephone investigation to determine if upholstered furniture was the first material ignited. If the
first material ignited was upholstered furniture, conduct an on-site investigation. Be sure to capture how the item
ignited.
Rationale for Obtaining Investigations
Upholstered furniture fires were associated with an estimated 370 civilian deaths in 2016. These included an
estimated 220 deaths where the heat source was smoking materials and an estimated 150 deaths from fires started by
other heat sources for upholstered furniture (e.g., space heaters, extension cords, outlets).
The upholstered furniture fire investigations will be used for two chief purposes: first, they will be used to determine
the hazard scenarios for smoking materials, small open-flame, and other types of ignitions of furniture. Second, the
investigations will be used to evaluate the effect of potential standards on fire casualties and property losses.
Consequently, the investigation guideline focuses on the people in the structure at the time of the fire; in particular,
their locations, conditions, and their abilities to escape the fire.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

Children’s Wearing Apparel (BUNN11)
CATEGORY ID: BUNN11
CATID Owner: Jacqueline Campbell

Appropriate Guideline: Children’s Wearing Apparel – Appendix 23A
Analysts:
Compliance contacts:

Jacqueline Campbell, ESEF, 301-987-2024, jcampbell@cpsc.gov
Paige Witzen, LSE, 301-987-2029, pwitzen@cpsc.gov
Carolyn Carlin, CRE, 301-504-7889, ccarlin@cpsc.gov
Troy Whitfield, CRE, 301-504-7548, TWhitfield@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Investigate all cases that involve ignition, melting, or smoldering of all types of garments worn by children under
age 15. Injuries that relate to the amendment of the children's sleepwear standards, that is, cases involving infants
and cases involving garments worn by children that can be classified as “snug fitting,” are of particular interest.
Some cases may involve clothing not marketed as sleepwear, such as underwear, playwear, or oversized adult tshirts that were used by children as sleepwear.
Do an onsite investigation only if a sample of the sleepwear garment can be obtained or viewed. Otherwise, conduct
a telephone investigation. Collect the entire garment, if possible, so that flammability can be tested and the garment
can be measured to determine if it is of the required proportions; samples as small as 1 square inch from undamaged
areas can be useful to determine the fiber content, fabric construction, and if the fabric had a flame-retardant finish.
Rationale for Obtaining Investigations
Currently, there are two flammability standards in effect for children's sleepwear, one for sizes 0 through 6X, the
other for sizes 7 through 14. The Commission voted in 1996 to amend the standards to exempt from regulation
garments intended for infants (size 0-9 months) and tight-fitting garments. Investigations will be used to gather
information regarding the effects of the amendment and to determine the involvement of other types of clothing.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

Candles (or Candle Accessories) (BUNN41)
CATEGORY ID: BUNN41
CATID Owner: David Miller

Appropriate Guideline:

Candle Fires & Fire Hazards – Appendix 121
Smoke Detectors/Alarms – Appendix 129

EPHA Analyst:
Backup contact:
Compliance contact:

David Miller, EPHA, (301-504-7323, dmiller@cpsc.gov
Yeon Kim, ESEF, 301-987-2258, YKim@cpsc.gov
Joseph Williams, CDI, 301-504-7585, jfwilliams@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Headquarters will make assignments. In general, assignments will be made based on reports from fire departments,
newspaper clippings, and other sources, only if the candle (or accessory) malfunctioned in an addressable way.
Rationale for Obtaining Investigations
Candles or candle accessories as the source of heat of ignition are one of the leading causes of residential fires.
CPSC staff worked with an ASTM subcommittee to develop a voluntary standard on candle fire safety, and work is
being done on separate voluntary standards for gel candles and candle accessories. In 2016, there were an estimated
5,300 candle fires that resulted in 70 deaths and 600 injuries. This data collection will help to identify the products
involved, their characteristics, and how they were being used.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

Fireworks Devices (CARM02)
CATEGORY ID: CARM02
CATID Owner: Jason Ng

Appropriate Guideline: Fireworks – Appendix 109
EPHA Analyst:
Product Expert:
Compliance contact:

Yongling Tu, EPHA, 301-504-7841, ytu@cpsc.gov
Rodney Valliere, LSC, 301-987-2526, rvalliere@cpsc.gov
Jason Ng, CRE, 301-504-7848, JNg@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all incidents that result in serious injuries or deaths associated with any fireworks device. “Serious injuries”
are defined as injuries requiring admission to the hospital for medical treatment.
Also assign all incidents associated with the following, even if no injuries are involved:
•

Large, illegal firecracker-type devices, such as M-80s, M-100s, M-1000s, “quarter” or “half” sticks, silver
salutes, tennis or ping pong ball “bombs.”

•

Chemicals or components for constructing the illegal fireworks devices listed above or actual completed
devices made from components (including chemicals, casings, end plugs, and fuses).

•

Pest control devices used as fireworks. These are typically cylindrical devices approximately 3” long. They
may have a fuse or German labeling.

•

Professional (1.3G, UN0335, formerly Class B) fireworks that were sold to or used by a consumer.

Rationale for Obtaining Investigations
The staff is actively involved in enforcing the Commission's ban on firecrackers which contain in excess of 50
milligrams of powder and other noise-making devices that contain more than 2 grains (130 mg) of powder.
Commission staff is also enforcing the labeling and performance requirements for consumer fireworks and
pyrotechnics offered or sold to consumers. In addition, the Commission published a notice of proposed rulemaking
in February 2017, which may lead to possible amendments to the fireworks regulations. Incident information is
needed to monitor compliance with regulations and to follow up on any firms found selling devices in violation of
them.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

Multi-Purpose Lighters (CARM11)
CATEGORY ID: CARM11
CATID Owner: Julio Alvarado

Appropriate Guideline: Lighter Fires – Appendix 45
(See note below in Criteria for other guidelines.)
Compliance contact:
Backup contact:

Julio Alvarado, CRE, 301-504-7418, jalvarado@cpsc.gov
Rik Khanna, EXHR, 301-987-2508, rkhanna@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all residential fires caused by child playing with multi-purpose lighters in which the fire was ignited by a
child under age 5 years or of unknown age. Products may be referred to as grill, barbecue, candle, utility, gas-match,
or fireplace lighters. Most are wand-like in shape; micro-torches are included. If possible, try to collect the lighter
involved in the fire or any pieces of it that may have been recovered. If the lighter ignited Upholstered Furniture
(Appendix 19), Mattresses & Bedding (Appendix 15), Children’s clothing (Appendix 23A), or Clothing on person
age 15 or older (Appendix 23), please provide the information requested in those Guidelines and Data Record Sheets
as well. If Smoke Detector/Alarm was present, use Appendix 129.
Rationale for Obtaining Investigations
Instances of suspected noncompliance with the Safety Standard for Multi-Purpose Lighters (16 C.F.R. part 1212)
will be assigned for investigation.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

LP and NG Gas Systems (BUNN39)
CATEGORY ID: BUNN39
CATID Owner: Ronald Jordan

Appropriate Guidelines:

Liquefied Petroleum (LP) Gas Fuel Train – Appendix 97
Control Panel - Gas Ranges – Appendix 138

Technical contact:
Backup contact:
Compliance contact:

Ronald Jordan, ESMC, 301-987-2219, RJordan@cpsc.gov
Yeon Kim, ESEF, 301-987-2258, YKim@cpsc.gov
Joseph Williams, CDI, 301-504-7585, jfwilliams@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Investigate all explosion and fire incidents reportedly involving a LP gas system.
Rationale for Obtaining Investigations
Investigations will support the work of the Combustion Appliance PAT team in evaluating, monitoring, and
recommend changes to the voluntary standards for fuel-burning products.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Fire-Related Hazards

High-Energy Density Rechargeable Battery Fires
(BUNN04) [Lithium-ion (Li-Ion), Nickel-Metal Hydride (NiMH), Lead-acid, Nickel-Cadmium (Ni-Cd, NiCad)]
CATEGORY ID: BUNN04
CATID Owner: Doug Lee

Appropriate Guideline:

Guidelines as indicated for specific electrical and battery powered products,
IoT/Connected Products – Appendix 140
Hoverboard Guidelines, CPSC Hazmat Guidelines

EPHA Analyst:
Project/Program Lead:
Compliance contact:
Backup Contact:

Matthew Hnatov, EPHA, 301-504-7403, mhnatov@cpsc.gov
Doug Lee, EXHR, 301-987-2073, dlee@cpsc.gov
Blake Rose, CDI, 301-504-7613, BRose@cpsc.gov
Jay Kadiwala, ESEF, 301-987-2517, JKadiwala@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all injuries and deaths related to fires and explosion from rechargeable battery products. Otherwise, one of
the contacts listed above will make assignments. Specific instructions will be issued at the time investigations are
assigned. This category will be used for assigning cases involving products associated with overheating, fire, shock,
and related physical injury incidents.
Assign for fires involving rechargeable batteries, including the following products:
a)
b)
c)
d)
e)
f)
g)
h)
i)

Laptops;
Tablets;
Mobile phones;
Power banks or portable battery packs (including automotive jumpstarters);;
Personal transportation equipment (hoverboards, scooters, e-bikes);
Lighting;
Baby monitors;
Power tools; and
Toys.

Rationale for Obtaining Investigations
The investigations will be used to evaluate the effectiveness of existing standard requirements and assess need for
new standards/requirements in battery-powered consumer products. The staff will be monitoring and encouraging
industry voluntary action to upgrade or develop new standards or requirements. This is part of the Commission’s
effort to evaluate and mitigate risks with high-energy density batteries in consumer products.
Additionally, the CPSC and outside stakeholders are focused on the Internet of Things (IoT) and its safety and
security. CPSC have been collecting incident data involving electrical appliances and other electrical equipment that
are remotely controlled over the internet to assess safety hazards caused by being remotely connected to the internet
(within CPSC’s jurisdiction).

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Electrical and Mechanical Hazards

Electrical Hazards, General (ELNN01)
CATEGORY ID: ELNN01
CATID Owner: Doug Lee

Appropriate Guidelines:

Electrocution/Electric Shock – Appendix 34
IoT/Connected Products – Appendix 140
Other guidelines as indicated for specific electrical products

Technical contact:
EPHA Analyst:
Backup contact:

Doug Lee, EXHR, 301-504-2073, DLee@cpsc.gov
David Miller, EPHA, 301-504-7323, dmiller@cpsc.gov
Arthur Lee, ESEF, 301-987-2008, alee@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign for electrocution/electric shock or fires involving the following products:
1. Cooktops and range/ovens, electric or gas;
2. Clothes dryers, electric or gas;
3. Electric heaters (fixed-position or portable);
4. Power cords. This includes extension cords, relocatable power taps (power or outlet strips), and
detachable or permanent connected cords on electrical products;
5. GFCI receptacles or GFCI circuit breakers;
6. AFCI receptacles or AFCI circuit breakers; and
7. Other appliances with significant burning, charring, or fire.
In addition, assign for only shocks/electrocutions involving the following products:
1. Class 2 power supplies, such as adaptors, ac chargers, power supply cords for laptops, cell phones, tablets;
and
2. All other products resulting in an electrocution*.
In general, headquarters will make assignments. Specific instructions will be issued at the time investigations are
assigned. This category will be used for assigning cases involving products associated with electric shock and
electrical fire incidents.
Rational for Obtaining Investigations
From 2014 through 2016, there were an estimated annual average of 640 fatalities and several thousand injuries due
to electrical fires. There was an annual estimated average of 48 electrocutions involving consumer products from
2010 through 2013. In addition to these deaths and injuries, property damages due to electrical fires averaged to
about $1.6 billion annually. Over half of the fires, deaths, and injuries are associated with a few products.
Assignments of electrical fires and shocks associated with consumer products will help the Commission to evaluate
the effectiveness of its involvement in electrical voluntary standards development.
Additionally, the CPSC and outside stakeholders are focused on the Internet of Things (IoT) and its safety and
security. CPSC have been collecting incident data involving electrical appliances and other electrical equipment that
are remotely controlled over the internet to assess safety hazards caused by being remotely connected to the internet
(within CPSC’s jurisdiction).
*Electrocution meaning electric shock resulting in death.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Electrical and Mechanical Hazards

Power Equipment, General (TLNN01)
CATEGORY ID: TLNN01
CATID Owner: John Topping

Appropriate Guidelines:

Table/Bench Saws – Appendix 76
Radial Arm Saws & Mitre Saws – Appendix 67

EPHA Analyst:
Technical contacts:
Compliance contact:

John Topping, EPHA, 301-504-7329, jtopping@cpsc.gov
Caroleene Paul, ESMC, 301-987-2225, cpaul@cpsc.gov
Blake Rose, CDI, 301-504-7613, brose@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all deaths or serious injuries that required hospitalization associated with table saws, radial arm saws, miter
saws.
(Specific instructions should be discussed with analysts or one of the Technical Contacts. Use SF 182 and
Investigation Guidelines.)
Rationale for Obtaining Investigations
The Commission staff will monitor serious injuries and deaths with various types of power equipment.
Investigations will be used to evaluate the effectiveness of standard requirements to identify new hazards, or to
support standards development efforts. Specific instructions will be given at the time of assignment.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Electrical and Mechanical Hazards

Chain Saws (TLNN15)
CATEGORY ID: TLNN15
CATID Owner: John Topping

Appropriate Guideline:

Chain Saws – Appendix 2

EPHA Analyst:
Technical contact:
Compliance contact:

John Topping, EPHA, 301-504-7329, jtopping@cpsc.gov
Caroleene Paul, ESMC, 301-987-2225, CPaul@cpsc.gov
Blake Rose, CDI, 301-504-7613, brose@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all injuries and deaths related to chain saw KICK-BACK incidents. Please use Appendix 2 for a guideline
and data record sheet in the investigation. Use SF 182 and NARRATIVE. Obtain copy of medical examiner’s or any
other official reports in case of fatality.
Rationale for Obtaining Investigations
The investigations will be used to evaluate the effectiveness of standard requirements ANSI B175.1-2012 for
gasoline-powered chain saws and UL 1662 for electric powered chain saws. The staff will be monitoring and
encouraging industry voluntary action to upgrade these standard requirements.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Electrical and Mechanical Hazards

Automatic Garage Door Operators (CARM10)
CATEGORY ID: CARM10
CATID Owner: Blake Rose

Appropriate Guideline: Automatic Residential Garage Door Operators – Appendix 87
Compliance contacts:

Blake Rose, CDI, 301-504-7613, brose@cpsc.gov
Troy Whitfield, CRE, 301-504-7548, twhitfield@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all incidents in which victims become entrapped and die or are seriously injured by the automatic garage
doors. Investigation Guideline # 87 should be followed.
Rationale for Obtaining Investigations
Investigations will help the Commission's effort to measure the effectiveness of the requirements in the mandatory
standard addressing entrapment incidents.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Electrical and Mechanical Hazards

Glass in Doors, Storm Doors, Patio Doors, and Tub &
Shower Doors and Enclosures (CARM05)
CATEGORY ID: CARM05
CATID Owner: Daniel Dunlap

Appropriate Guideline:

Architectural Glass – Appendix 52

Compliance contact:
Technical contact:

Daniel Dunlap, CRE, 301-504-7733, DDunlap@cpsc.gov
Brian Baker, LSM, 301-987-2289, bbaker@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign incidents involving injury resulting from the breakage of glass in any of the products listed in the title above.
Obtain specific measurements of all glass panels incorporated in the involved product design. If possible, obtain a
photo and/or a sample of the broken glass. Before the investigation, a determination should be made by telephone of
when the product was installed. If the product was purchased (or the glass was installed) before July 7, 1977, do not
complete an on-site investigation. In these cases, complete the form 182 and report findings. If the product was
purchased after July 7, 1977, or the glass was installed after July 7, 1977, an on-site investigation should be made.
Rationale for Obtaining Investigations
16 CFR part 1201 includes safety requirements designed to reduce or eliminate unreasonable risks of death or
serious injury to consumers when glass is broken by human contact. An investigation may uncover unsafe products
that contain glass that does not comply with the Architectural Glazing standard, and thus, facilitate Commission
enforcement of the standard.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Toys (TYNN01)
CATEGORY ID: TYNN01
CATID Owner: Yongling Tu

Appropriate Guidelines:

Small Parts – Appendix 48
Toys – Appendix 27
Structural Entrapment – Appendix 35

EPHA Analyst:
Engineering contacts:

Yongling Tu, EPHA, 301-504-7841, ytu@cpsc.gov
Susan Bathalon, EXHR, 301-987-2282, SBathalon@cpsc.gov
Ben Mordecai, LSM, 301-987-2506, BMordecai@cpsc.gov
Health Sciences contact: Suad Wanna-Nakamura, HSPP, 301 987 2550, snakamura@cpsc.gov
Compliance contact:
Carolyn Manley, CRE, 301-504-7607, cmanley@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all deaths involving children associated with toys.
Rationale for Obtaining Investigations
Serious incidents involving children's toys continue to be of interest to the Commission, staff, and consumers. There
are frequent requests for updated information. Findings from investigations continue to be used for various safety
efforts, including voluntary standards activities, mandatory standards, and review in accordance with Section 106 of
the 2008 Consumer Product Safety Improvement Act of 2008 (CPSIA), and public awareness campaigns, such as
during the holiday season. Of particular interest are incidents involving swallowed magnets, impactions and choking
risks of small toys in the throat of victims, projectile toys, and fires caused by batteries.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Nursery Equipment (TYNN31)
CATEGORY ID: TYNN31
CATID Owner: Risana Chowdhury

Appropriate Guidelines:

Nursery Products – Appendix 46
Structural Entrapment – Appendix 35

Children’s Program Manager:
Hope Nesteruk, ESMC, 301-987-2579, hnesteruk@cpsc.gov
EPHA Analyst:
Angie Qin, EPHA, 301-504-7810, AQin@cpsc.gov
Compliance contacts:
(Cribs) Justin Jirgl, CRE, 301-504-7814, jjirgl@cpsc.gov
Carolyn Manley, CRE, 301-504-7607, cmanley@cpsc.gov
(Nursery Products) Keysha Walker, CRE, 301-504-6820, kwalker@cpsc.gov
Criteria for Assigning Non-NEISS Investigations
There are specific questions that have been developed for sleep-environment products that need to be asked at the
time of investigation, and these will be provided at the time of assignment from Headquarters. Furthermore, there
are additional documents available through Headquarters (besides the guidelines above) that provide very specific
guidance on certain hardware and mattress-fit-related issues. Prior to initiating an assignment on a sleep
environment product, if the assignment involves a crib, contact Justin Jirgl to check if he has specific questions
regarding the investigation, otherwise contact a member of the Team above for further guidance.
For all other nursery products, cases will usually be assigned from Headquarters. Prior to initiating an assignment on
a durable nursery product, contact the CPSIA project manager for that product, or Hope Nesteruk, Children’s
Program Manager.
Rationale for Obtaining Investigations
Information on deaths, entrapments, other “near miss” non-fatal incidents, and serious injuries involving nursery
equipment is important in evaluating the need for revisions to voluntary or mandatory standards as mandated by
CPSIA. As indicated in the Criteria section above, if Field initiates any investigation on a nursery product,
consultation with Headquarters staff first will ensure that any specific questions are answered. In general, we are
interested in incidents involving failures of the nursery equipment.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Playground Equipment (TYNN32)
CATEGORY ID: TYNN32
CATID Owner: Khalisa Phillips

Appropriate Guideline:

Playground Equipment – Appendix 39

Primary contact:
EPHA Analyst:
Compliance contact:

Khalisa Phillips, ESHF, 301-987-2592, kphillips@cpsc.gov
James Tark, EPHA, 301-504-7707, JTark@cpsc.gov
Blake Rose, CDI, 301-504-7613, BRose@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all deaths and serious head injuries to children that involved playground equipment. Where a “fall” has
occurred, please document the fall height and specific injury especially if the fall is less than 2 feet. Also, make note
of the playground surface material, including the depth of loose surfacing. Communicate with the primary contact to
coordinate a technical staff to potentially visit the site to conduct impact testing.
Rationale for Obtaining Investigations
Information on serious incidents involving playground equipment will be used in the revision of the voluntary
standards for home playground equipment, public playground equipment, soft contained playground equipment
often found in "pay-for-play" settings or fast food restaurants, and in the development of voluntary standards for
public playground equipment intended for very young children. Incidents involving entrapment are of particular
concern, as are head injuries from falls.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Children’s Products, General (TYNN05)
CATEGORY ID: TYNN05
CATID Owner: Hope Nesteruk

Appropriate Guidelines:

Use those issued for specific products

EPHA Analyst:
Backup contact:
Compliance contacts:

Risana Chowdhury, EPHA, 301-504-7334, rchowdhury@cpsc.gov
Hope Nesteruk, ESMC, 301-987-25479, hnesteruk@cpsc.gov
Carolyn Manley, CRE, 301-504-7607, cmanley@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Deaths and serious injuries associated with children's products may be assigned throughout the year, depending
upon Commission requirements. A newly identified serious emerging hazard involving a children’s product may
also be assigned under this category. These assignments should be made after consultation with Headquarters staff.
Rationale for Obtaining Investigations
Serious incidents involving children's products are of continued interest to the Commission and there are frequent
requests for additional information. In addition, in support of CPSIA, there may be renewed interest in specific
children’s products which may, in turn, generate an increased number of requests for in-depth investigations on
various children’s products.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Childhood Pool/Spa & Fatal Submersions/Drownings
(TYNN26)
CATEGORY ID: TYNN26
CATID Owner: Ted Yang

Appropriate Guideline: Swimming Pools, Spas, & Hot Tubs – Appendix 75
EPHA Analyst:
Compliance Contact:
Backup contacts:

Ted Yang, EPHA, 301-504-7838, tyang@cpsc.gov
Troy Whitfield, CRE, 301-504-7548, twhitfield@cpsc.gov
Susan Bathalon, EXHR, 301-987-2282, sbathalon@cpsc.gov
Brian Baker, LSM, 301-987-2289, BBaker@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign for follow-up telephone investigation fatal submersion/drowning incidents of children younger than 5 years
of age associated with pools and spas only after consultation with headquarters staff. For incidents involving pool
and spa entrapments, please refer to C&R entry for Pool and Spa Entrapments.
It is important to collect as much information about the type of pool/spa and the incident scenario. The latest
version of the annual pool or spa submersion report can be found at: https://www.cpsc.gov/s3fspublic/Pool_or_Spa_Submersion_Estimated_Nonfatal_Drowning_Injuries_and_Reported_Drownings_May_2019.pdf?mW8FxiPVFOI3UErKze
PwJ.JNoCc79yY5

Rationale for Obtaining Investigations
There were, on average, 4,800 pool- and spa- related emergency department (ED)-treated submersion injuries each
year from 2016 to 2018, and 269 pool and spa related fatalities per year from 2014-2016 involving children younger
than 5 years of age. Fatal submersions/drownings are one of the leading causes of death for young children but, with
efforts from the safety community, appear to be holding steady.
There are several types of residential swimming pools, including in-ground and above-ground pools. Children can
also drown in spas or hot tubs. Within the above-ground portable swimming pool category, several construction
designs are available to consumers. In particular, inexpensive, large, deep, portable pools that can accommodate
several adults and children, and large portable juvenile pools with elaborate built in play activities are part of the
consumer market. Also, recreational spa (hot tub) products are becoming less expensive and more widely available
to consumers. The extent to which these products are influencing drowning data is not yet clear, but certainly
traditional layers of protection against drowning such as 4-sided fencing are less likely to be used with these
products.
Portable Pools: A portable pool is classified as any pool that can be set up/taken down or moved to another location
with relative ease. There are three categories of portable pools:
•
•
•

Inflatables – pools with an air-filled rim and flexible sides that are held up by the water pressure in the pool. They are
also called “soft-sided, self-rising, or self-setting” pools, because the walls rise into place as the water is added.
Framed portable pools – pools that have a tubular metal or plastic frame attached to some type of flexible material that
forms the pool.
Wading pools – pools that are less than 18 inches deep. Some have rigid sides and some are inflatable. This does not
include in-ground wading pools.

To develop more effective drowning prevention strategies, it is essential to have a good understanding of products
involved in drowning incidents and the layers of protection that were in place. As such, staff is emphasizing the
continued need to collect detailed information on pool and spa incidents. Each year the data collected is used for an
annual report on pool and spa drowning statistics, that also attempts to identify newly emerging product hazards,
such as the large deep portable pools. The collective updated information is also used for CPSC’s annual drowning
prevention educational campaign. Other groups use this information as well to work on this issue.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Pool and Spa Entrapments (TYNN26)
CATEGORY ID: TYNN26
CATID Owner: Ted Yang

Appropriate Guideline:

Swimming Pools, Spas, & Hot Tubs – Appendix 75

EPHA Analyst:
Compliance contact:
Technical contact:

Ted Yang, EPHA, 301-504-7838, TYang@cpsc.gov
Troy Whitfield, CRE, 301-504-7548, TWhitfield@cpsc.gov
Mark Eilbert, LSM, 301-987-2232, meilbert@cpsc.gov

It is important to collect as much information about the type of product(s) and the incident scenario. The
latest version of the circulation/suction entrapment report can be found at
https://www.cpsc.gov/s3fs-public/2019_Circulation_Entrapment.pdf?IzoaBlClbtP70RRVUJqPK3RI4Ikxyety

Criteria for Assigning Non-NEISS Investigations
Assign for on-site investigation all fatal and non-fatal incidents (involving victims of any age) that involved
entrapment, especially in the drainage system of a pool, spa (hot tub) only after consultation with headquarters staff.
If the incident involved a public pool or spa, please contact Troy Whitfield, CRC, for specific instructions.
Rationale for Obtaining Investigations
From 2014 to 2018, CSPC staff received reports of 11 incidents of circulation/suction entrapments including: two
fatalities and nine injuries related to pools, spas, and whirlpools. Spas are used primarily for recreation whereas
whirlpools are for bathing. CPSC staff issued 2005 guidelines for reducing pool and spa entrapment hazards.
Investigation of entrapment cases will allow staff to assess the efficacy of these guidelines. With the Pool and Spa
Safety Act, there is emphasis on making public pools and spas safer. When these entrapment incidents occur, the
detailed information collected is vital to determine whether pools and spas are meeting requirements or if new
entrapment issues need to be addressed. The entrapment data is updated at least annually, and this information is
shared with groups working on these issues.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Infant Bathing Product Fatal Submersions/Drownings
(TYNN26)
CATEGORY ID: TYNN26
CATID Owner: Ted Yang

Appropriate Guidelines:

Bathtub Incidents – Appendix 111
Baby Bath Seats – Appendix 130

EPHA Analyst:
Backup contact:
Compliance contacts:

Ted Yang, EPHA, 301-504-7838, tyang@cpsc.gov
Celestine Kish, ESHF, 301-987-2547, ckish@cpsc.gov
Keysha Walker, CRE, 301-504-6820, kwalker@cpsc.gov

It is important to collect as much information about the type of product(s) and the incident scenario. The
latest version of the annual at-home submersion/drowning report can be found at
http://www.cpsc.gov/pagefiles/129419/nonpoolsub2012.pdf.
Criteria for Assigning Non-NEISS Investigations
For fatal submersion/drowning incidents involving children 12 months and younger that occurred in bathtubs and/or
involved other infant bathing products, please assign for follow-up telephone investigation only after consultation
with headquarters staff. Please note any infant bathing products that were used at the time of the incident.
The following product definitions and classifications were developed in an effort to better clarify the incident data:
• Bath seat – A product that contains a bottom for sitting. It is used for an occupant who is seated upright
(80-110 degrees). It provides some level of rigid support to the occupant’s back, sides, and/or front. It is not
intended to retain water and is not inflatable.
• Bath ring – Similar to a bath seat, but with no integral seat bottom (a ring on top with columns that attach
to the tub). If there is a seat bottom, it is removable and could be made of a foam type of material.
• Infant bathtub – A portable rigid structure intended to retain water.
• Bathing aids – Other miscellaneous devices not included above. This could include cushions (not
inflatable) or other products used for bathing.
• Combination – A product that can be more than one of the above such as a bath seat/ infant bathtub
product where, based on its configuration, it can be either.
• Infant sling – A cloth attached to an infant bathtub or frame for use in an infant bath tub.
• Infant bather – A cloth attached to a frame that can be used with an infant bath tub or directly in an adult
tub or sink. It is not intended to retain water.
Rationale for Obtaining Investigations
From 2006 to 2010, CSPC staff is aware of 289 fatal submersions involving children younger than 12 months of age
in bathing products. The infant bathing product market is changing and surveillance is needed to stay informed of
new products and hazards involved with these fatalities.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Infant Fatal Suffocation (TYNN06)
CATEGORY ID: TYNN06
CATID Owner: Suad Wanna-Nakamura

Appropriate Guidelines: Use appropriate guidelines
Program/Project Manager:
Backup contacts:
Compliance contact:

Suad Wanna-Nakamura, HSPP, 301 987 2550, snakamura@cpsc.gov
Jacqueline Ferrante, HSPP, 301-987-2607, JFerrante@cpsc.gov
Hope Nesteruk, ESMC, 301-987-2579, hnesteruk@cpsc.gov
Keysha Walker, CRE, 301-504-6820, kwalker@cpsc.gov

It is important to collect as much information about the type of product(s) and the incident scenario.
Be sure to include all above contacts in the distribution of the completed IDI.
Criteria for Assigning Non-NEISS Investigations
For fatal suffocation incidents involving children under 12 months of age that occurred in infant sleep products, such
as cribs, bassinets, play yards, inclined sleep products, on pillows and on adult beds, air mattresses, . . . and/or
involved other infant products, please assign for follow-up telephone investigation only after consultation with HS
staff. Please note any infant products that were used at the time of the incident. For specific instructions, contact HS
staff.
The following product definitions and classifications were developed in an effort to better clarify the incident data
in infant sleep products as defined in Section 104(b) of the CPSIA.
Cribs are defined as either full-size or non-full-size:
• “A full-size crib has specific interior dimensions of 28 ± 5/8 inches (71 ± 1.6 centimeters) in width and
523/8 ± 5/8 inches (133 ± 1.6 centimeters) in length and is designed to provide sleeping accommodations
for an infant.”
• “A non-full-size crib may be either smaller or larger than a full-size crib, or shaped differently than the
usual rectangular crib. The category of non-full-size cribs includes oversized, specialty, undersized, and
portable cribs, but does not include any product with mesh/net/screen siding, non-rigidly constructed
cribs, cradles, car beds, baby baskets, or bassinets. The CPSC standard for non-full-size cribs does not
apply to play yards, which are mesh or fabric-sided products.”
• See: https://www.federalregister.gov/documents/2010/12/28/2010-32178/safety-standards-for-full-sizebaby-cribs-and-non- full-size-baby-cribs-final-rule.
Bassinet/cradle is defined as a small bed designed primarily to provide sleeping accommodations for infants,
supported by free standing legs, a stationary frame/stand, a wheeled base, a rocking base, or which can swing
relative to a stationary base.” While in a rest position, a bassinet/cradle is intended to have a sleep surface less than
or equal to 10° from horizontal. The bassinet/cradle is not intended to be used beyond the age of approximately
five months or when a child is able to push up on his hands and knees. Bassinet and cradle attachments for nonfull-size cribs or play yards are considered part of the bassinet/cradle category, as are bedside sleepers that can be
converted to four-sided bassinets not attached to a bed.
See: https://www.federalregister.gov/documents/2013/10/23/2013-24203/safety-standard-for-bassinets-andcradles.
Play yards are defined as a “framed enclosure that includes a floor and has mesh or fabric sided panels primarily
intended to provide a play or sleeping environment for children. It may fold for storage or travel.” Play yards are
intended for children who are less than 35 inches tall, who cannot climb out of the product. Some play yards include
accessory items that attach to the product, including mobiles, toy bars, canopies, bassinets, and changing tables.
See: https://www.federalregister.gov/documents/2012/08/29/2012-21168/safety-standard-for-play-yards.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Inclined Sleep products, such as:
• Hammocks (typically constructed of fabric and suspended from one or two points, either above or on
either side; constructed of various materials; generally conform to the shape of the child when placed in
the product; can either be supported by a frame or other structure, such as a ceiling);
• Newborn or infant frame type (intended to be placed on the floor; self-supporting; typically use a metal
frame with a rigid or semi-rigid sleeping surface; base may be stationary or allow side to side rocking;
may be intended for use by either newborns or infants, or both, depending on the size);
• Compact (freestanding with the bottom of the seat a maximum of 6 inches above the floor; generally
constructed of foam with a fixed seat back angle between 10° and 30°; intended to be used on the floor);
and
• Products intended for use with newborns are generally similar in design to products intended for infants,
except that products intended for use with newborns have a seat back length of 17 inches or less.
• See: https://www.federalregister.gov/documents/2017/04/07/2017-06875/safety-standard- for-infantinclined-sleep-products.
Other products used/advertised for sleep and non-regulated products (i.e., no performance standard), such as:
• positioners, a host of sleep aid products, can be more than one product
• positioner devices
Products used but not intended for infant sleep
• adult beds
• toddler beds
• standard mattresses and air mattresses
Rationale for Obtaining Investigations
Commission in rulemaking for crib bumpers, crib mattresses, inclined sleep products.
Frequent questions about other suffocation hazards including air mattresses, and provide guidance to caregivers on
hazards associated with products not intended for infants to sleep in/on.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Childhood Fatalities Involving Instability or Tip-over of
Televisions, Furniture, and Appliances (TYNN40)
CATEGORY ID: TYNN40
CATID Owner: Adam Suchy

EPHA Analyst:
Health Science contact:
Engineering contact:

Adam Suchy, EPHA, 301-504-7301, asuchy@cpsc.gov
Suad Wanna-Nakamura, HSPP, 301 987 2550, snakamura@cpsc.gov
Michael Taylor, LSM, 301-987-2338, MTaylor@cpsc.gov

It is important to collect as much information about the type of product(s) and the incident scenario. The
latest version of the instability or tip-over report can be found at www.cpsc.gov. Search for the report by
document title “Product Instability or Tip-Over Injuries and Fatalities Associated with Televisions, Furniture,
and Appliances.”
Criteria for Assigning Non-NEISS Investigations
Assign for on-site investigations fatalities involving instability or tipover of furniture, appliances, and televisions
only after consultation with headquarters staff.
Rationale for Obtaining Investigations
For 2015-2017, on average, there were 28,300 instability or tip-over injuries treated annually in emergency
departments related to televisions, furniture, and appliances. For 2000-2017, 542 instability or tip-over fatalities
were associated with televisions, furniture, and appliances. To develop effective intervention strategies, it is
important to have a good understanding of the incident scenarios (age of victim, activities, and behaviors of the
victims prior to the incident) and specific characteristics of products involved (such as dimensions, for televisions
whether it is a flat screen or a CRT, the locations of the feet of the furniture relative to the front of the unit involved,
and the type of flooring that the furniture rested upon, and whether the item was anchored). This is particularly
important when major changes in available product designs and consumer consumption happen within a relatively
short time, as is happening with televisions. Staff is monitoring fatalities involving instability and tip-over of
televisions, furniture, and appliances to determine key details and factors involved. This information will be used to
inform the public about ways to avoid this poorly recognized hazard scenario, and might lead to safer product
designs.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Children’s Products

Childhood Injuries and Fatalities Involving Corded
Window Coverings (TYNN45)
CATEGORY ID: TYNN45
CATID Owner: Christopher Nguyen

Includes blinds, shades, curtains, drapery, and room dividers
Appropriate Guideline:

Window Covering Cords – Appendix 136

Compliance contact:
Technical contact:

Christopher Nguyen, CDI, 301-504-7871, CNguyen@cpsc.gov
Rana Balci-Sinha, ESHF, 301-987-2584, rbalcisinha@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Investigate fatalities and injuries involving corded window coverings only after consultation with headquarters staff.
Rationale for Obtaining Investigations
CPSC staff is aware of more than 180 fatalities and over 100 non-fatal incidents related to corded window coverings
that were reported to have occurred since 1996. To develop effective intervention strategies, it is important to have a
good understanding of the incident scenarios (age of victim, activities, and behaviors of the victims prior to the
incident) and specific characteristics of products involved. Investigations will be used to support compliance work
under Section 15 of the CPSA, to evaluate the effectiveness of voluntary standards, or to propose improvements in
the voluntary standards as well as conduct public awareness campaigns.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Chemical Hazards

Chemical Hazards, General (CHNN01)
CATEGORY ID: CHNN01
CATID Owner: Cheryl Scorpio

EPHA Analyst:
Backup contact:
Backup contact:
Compliance contact:
Compliance back-up:

Angie Qin, EPHA, 301-504-7810, aqin@cpsc.gov
Cheryl Scorpio, HSPP, 301-987-2572, cscorpio@cpsc.gov.
Kris Hatlelid, HSTR, 301-987-2558; KHatlelid@cpsc.gov
Stephanee Synnott, CRE, 301-504-7847, SSynnott@cpsc.gov
Stephen Lee, CRE, 301-504-7844, SLee@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Staff will periodically make assignments. Incidents involving chemicals contained in products not specifically
included in current Commission Operating Plan projects may be of particular interest. Incidents will be assigned
under this category as the need is identified by the subject matter experts. A specific questionnaire may be available
to investigate certain products. If there is a specific questionnaire, the assignment message will direct the
investigator to contact the analyst to obtain any such questionnaire prior to initiating an investigation.
Rationale for Obtaining Investigations
Information on the circumstances of chemical hazard incidents is needed to support work under the Federal
Hazardous Substances Act (FHSA) and the Consumer Product Safety Act (CPSA). Details on deaths and adverse
health effects involving a wide range of household products including furnishings, construction materials, and
appliances are needed to support work under the Commission’s toxicity assessment portion of the Chemical Hazards
Project. Investigations will be used to evaluate the need for product performance standards, warning labels for
product use and health hazards, and industry voluntary standards to reduce the risk of injury due to chemicals in
consumer products.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Chemical Hazards

Battery Ingestions (CHNN11)
CATEGORY ID: CHNN11
CATID Owner: Cheryl Scorpio

EPHA Analyst:
Backup contacts:
Compliance contacts:

Angie Qin, EPHA, 301-504-7810, aqin@cpsc.gov
Cheryl Scorpio, HSPP, 301-987-2572, cscorpio@cpsc.gov.
Doug Lee, EXHR, 301-987-2073, dlee@cpsc.gov
Carolyn Manley, CRE, 301-504-7607, cmanley@cpsc.gov
Sammy Sarwar, CRE, 301-504-7682, SSarwar@cpsc.gov
Blake Rose, CRE, 301-504-7613, BRose@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Staff will assign incidents involving children less than five years old. As a general rule, all battery ingestion
incidents involving hospitalization, serious health effects, or death should be assigned. A questionnaire is available
to investigate battery ingestions. Investigators should contact the analyst prior to initiating an investigation to obtain
any such questionnaire.
Rationale for Obtaining Investigations
Battery ingestions, especially involving small button or coin sized batteries, are a growing concern. At least 20
deaths have occurred from battery ingestions since 1995, and since 1998 the estimated number of emergency
department treated injuries has increased more than 2.5 times. Investigations will provide important information for
mitigating this hazard, including the precise type of battery ingested, the product the battery came from, and the
circumstances surrounding the child accessing the battery.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Chemical Hazards

Poison Prevention Packaging (PPPA) (CHNN08)
CATEGORY ID: CHNN08
CATID Owner: Cheryl Scorpio

EPHA Analyst:
Backup contacts:
Compliance contact:

Angie Qin, EPHA, 301-504-7810, aqin@cpsc.gov
Mark Eilbert, LSM, 301-987-2232, MEibert@cpsc.gov
Cheryl Scorpio, HSPP, 301-987-2572, cscorpio@cpsc.gov
Stephanee Synnott, CRE, 301-504-7847, SSynnott@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Staff will assign incidents involving children less than five years old. As a general rule, all incidents involving
hospitalization, serious health effects, or indications that a child-resistant (CR) closure was ineffective should be
assigned. A specific questionnaire may be available to investigate certain products or classes of products.
Investigators should contact the analyst prior to initiating an investigation to obtain any such questionnaire.
Rationale for Obtaining Investigations
Information on the circumstances of chemical hazard incidents is needed to support work under the Poison
Prevention Packaging Act. Investigations will be used to evaluate the need for and effectiveness of CR closures with
respect to specific products or product classes.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Chemical Hazards

Carbon Monoxide, General (STNN25)
CATEGORY ID: STNN25
CATID Owner: Matt Hnatov

Appropriate Guideline: All Carbon Monoxide (CO) Poisoning Related Incidents – Appendix 16
EPHA Analyst:
Backup contact:
Compliance contact:

Matthew Hnatov, EPHA, 301-504-7403, mhnatov@cpsc.gov
Ronald Jordan, ESMC, 301-987-2219, rjordan@cpsc.gov
Rik Khanna EXHR, 301-987-2282, rkhanna@cpsc.gov
Blake Rose, CDI, 301-504-7613, brose@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Investigate all deaths due to non-fire carbon monoxide (CO) from a consumer product (i.e. excluding motor vehicle
exhaust). Deaths and nonfatal incidents related to carbon monoxide emissions are also investigated with the
following products of special interest:
• portable LP gas camping heaters (including those that use 1 - 20 lb. tanks and commercial units – over
20,000 BTUs – used by consumers)
• camping lanterns
• gas-fired furnaces manufactured beginning in 1987
• gas-fired boilers
• gas wall furnaces
• vented and unvented gas space heaters
• tankless hot water heater
Use the guideline and data record sheets related to General Information, Injured Persons, CO Alarms (if applicable),
and Residence Environment. In addition, use the guideline and data record sheet applicable to the incident product.
If the product is vented, complete the data record sheet related to Condition of Vented Products.
Rationale for Obtaining Investigations
Investigations will support on-going work of the Combustion Appliance PAT team in evaluating, monitoring, and
recommending changes to the voluntary standards for fuel-burning products. CPSC staff has estimated that there
was an annual average of 162 non-fire, accidental CO poisoning deaths related to consumer products between 2013
and 2015. Investigations will also support the monitoring of voluntary standards for CO alarms.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Chemical Hazards

Carbon Monoxide Poisoning From Generators and
Engine Powered Consumer Products (STNN36)
CATEGORY ID: STNN36
CATID Owner: Matt Hnatov

Appropriate Guideline:

All Carbon Monoxide Poisoning-Related Incidents – Appendix 16
(See page 46 in Guideline)

EPHA Analyst:
Backup contact:
Compliance contact:
Backup contact:

Matthew Hnatov, EPHA, 301-504-7403, mhnatov@cpsc.goc
Janet Buyer, ESMC, 301-987-2293, jbuyer@cpsc.gov
Blake Rose, CDI, 301-504-7613, brose@cpsc.gov
Troy Whitfield, CRE, 301-504-7548, twhitfield@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Investigate all consumer injuries and deaths due to carbon monoxide (CO) from portable and stationary generators
and other engine-driven consumer products (e.g., power-washers or sprayers, floor buffers, riding mowers, ATVs).
Use the guideline, paying special attention to the section titled – Instructions for Collecting Specific Information on
Generators and Engine-Powered Consumer Products, and complete the data record sheets related to General
Information, Injured Persons, and CO Alarms (if applicable).
Rationale for Obtaining Investigations
Investigations will support the Portable Generator project. CPSC is aware of 834 CO poisoning fatalities from 645
incidents that were associated with engine-driven tools, or engine-driven tools used in conjunction with another
potentially CO emitting consumer product from 2008 through 2018. Eighty-nine percent of these fatalities were
associated with generators or generators used in conjunction with other fuel-burning products. From 2013 through
2015, generators were associated with about 40% of the total estimated CO deaths associated with consumer
products. In 2006, the Commission voted to publish an Advance Notice of Proposed Rulemaking to begin research
to develop technology to lower the risk of CO poisoning associated with portable generators. In 2016, the
Commission voted to publish an NPR that is based on reducing portable generators’ CO emission rates. The
information obtained from incident investigations is valuable in further evaluating the adequacy of the proposed rule
as well as alternative strategies, including two voluntary standards for portable generators that adopted CO hazard
mitigation requirements in 2018, to address the hazard.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Chemical Hazards

Carbon Monoxide Death Certificates (STNN34)
CATEGORY ID: STNN34
CATID Owner: Matt Hnatov

Appropriate Guideline:

EPHA Analyst:
Backup contact:
Compliance contact:

All Carbon Monoxide Poisoning-Related Incidents – Appendix 16
(for technical reference only)
Matthew Hnatov, EPHA, 301-504-7403, mhnatov@cpsc.gov
Rik Khanna, EXHR, 301-987-2282, rkhanna@cpsc.gov
Blake Rose, CDI, 301-504-7613, brose@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Headquarters will make assignments from death certificates, coroner’s or medical examiner’s reports where cause of
death was carbon monoxide (CO) poisoning / intoxication. Due to the lag in state reporting of death certificates and
due to the contact restrictions placed on investigations initiated from death certificates, investigators are not
required to complete the Appendix 16 Data record sheets for these assignments. If CO is determined to be due
to automobile exhaust or an intentional act, then investigators should complete a screening report as instructed in the
Field Manual for Investigation Procedures and Reporting Techniques.
NOTE: If the CO poisoning is determined to be fire-related AND there is no special study currently associated with
the product/hazard involved, then investigators should complete an abbreviated report as instructed in the Field
Manual for Investigation Procedures and Reporting Techniques.
Rationale for Obtaining Investigations
The CPSC Directorate for Epidemiology staff generates annual estimates of non-fire CO deaths associated with
consumer products. The percentage of CO deaths attributed to each type of consumer product is determined by the
information produced in these investigations. Any in-depth information surrounding these fatal scenarios adds to the
quality of information that can be shared with the public. The annual CO fatality estimates are used in Commission
safety announcements and press releases, and are of interest to the medical community and the gas appliance
industry.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Sports and Recreation

All-Terrain Vehicle (ATV) & Utility Vehicle (UTV) Deaths
(TYNN09)
CATEGORY ID: TYNN09
CATID Owner: John Topping

Appropriate Guideline:

All-Terrain Vehicles – Appendix 91

EPHA Analyst:
Project/program lead:
Compliance Defects Contact:
Compliance Regulatory Contact:

John Topping, EPHA, 301-504-7329, jtopping@cpsc.gov
Caroleene Paul, ESMC, 301-987-2225, CPaul@cpsc.gov
Blake Rose, CDI, 301-504-7613, BRose@cspc.gov
Daniel Dunlap, CRE, 301-504-7733, DDunlap@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all deaths: For all ATV fatalities, verify ATV involvement and provide a description of the accident
scenario. Complete the ATVD Online Questionnaire. Of particular interest is the number of wheels, brand, and
engine size of the ATV, as well as the ages of the victim and the driver and other essential information mentioned in
Appendix 91. If it is determined that the incident vehicle is a Utility Vehicle (UTV), complete the guideline
requirements for UTVs, located at the end of Appendix 91.
Rationale for Obtaining Investigations
An all-terrain vehicle is a vehicle with 3 or more wheels, a motor, a seat that the rider straddles, motorcycle-type
handlebars, and low-pressure tires. ATVs are designed for off-road use on a variety of surfaces and terrains.
ATV deaths continue to be of interest to the CPSC. The 2008 Consumer Product Safety Improvement Act (CPSIA)
required CPSC to mandate the ATV voluntary standard which has requirements for youth ATVs, engineering
standards, labeling, etc. In 2009, the mandatory standard became effective. CPSC periodically updates the
mandatory standard as the voluntary standard is revised. Investigations are used to evaluate standards and
rulemaking requirements.
In November 2014, CPSC published notice of proposed rulemaking for Recreational Off-Highway Vehicles
(ROVs). ROVs are off-highway vehicles that have four or more tires, a steering wheel, foot pedals, bench or bucket
seats, a roll cage, and can obtain speeds greater than 30 mph. UTVs can have some of the same characteristics, yet
some are not equipped with roll bars or cages and they cannot obtain speeds greater than 30 mph. These vehicles are
often called ATVs in reports of fatalities; however, these vehicles do not fit the CPSC definition of an ATV.
Separate guidelines have been included in Appendix 91 for UTVs, which include ROVs. The characteristics of the
driver, passengers, terrain, and incident are of interest in order to support the open rulemaking on ROVs. To aid in
distinguishing ROVs from UTVs and ATVs, the make, model, and engine size of the vehicle are of particular
interest.
For Distribution on the completed IDI, please include the following:
for ATVs

John Topping, Blake Rose, and Daniel Dunlap

for UTVs and ROVs

John Topping and Blake Rose

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Sports and Recreation

Sports-Related Deaths and Serious Injuries (TYNN33)
CATEGORY ID: TYNN33
CATID Owner: John Topping

EPHA Analyst:
Program/project lead:
Compliance contact:

John Topping, EPHA, 301-504-7329, jtopping@cpsc.gov
Rick McCallion, EXHR, 301-987-2222, RMCallion@cpsc.gov
Mel Altman, CDI, 301-504-7419, maltman@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Assign all deaths and serious injuries related to head, neck, and Commotio Cordis/chest impacts (not including
motorized vehicle-related incidents) to children under 15 years of age. For deaths involving soccer goal tipovers,
assign regardless of decedent’s age. If the death or injury resulted from an equipment failure, try to collect the
equipment or information regarding the manufacturer and model of the equipment involved.
Rationale for Obtaining Investigations
We are interested in trying to reduce the number of sports-related deaths and injuries to children. Among the
injuries, we are especially concerned about serious head injury. Reducing head injuries to children is one of the
Commission's stated objectives under the Government Performance and Results Act.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Sports and Recreation

Sports Helmet Project (TYNN34)
CATEGORY ID: TYNN34
CATID Owner: John Topping

Appropriate Guideline:

Youth Sports Helmets – Appendix 139

EPHA Analyst:
Program/project leads:

John Topping, EPHA, 301-504-7329, jtopping@cpsc.gov
Rick McCallion, EXHR, 301-987-2222, RMCallion@cpsc.gov
Ian Hall, LSM, 301-987-2323, IHall@cpsc.gov
Mel Altman, CDI, 301-504-7419, maltman@cpsc.gov

Compliance contact:

Criteria for Assigning Non-NEISS Investigations
The Youth Sport Helmets Project will explore the various types of head injuries that occur during youth contact
sports while helmets are being worn by the victims. The project will have investigators review incidents that involve
various sporting helmets (i.e., football, hockey, lacrosse, etc.).
We are interested in finding out the types of helmets worn by youth (18 and under) today, including the relative
levels of safety offered by the various designs. We will need to consider incident information in evaluating the
adequacy of the existing voluntary standards for helmets (e.g., ASTM, NOCSAE); as well as in determining if there
is the need for a mandatory helmet standard. Of particular interest are incidents in which the athletes incurred a head
or neck injury while wearing a helmet, or in which it appeared that the helmet didn't function properly (e.g., broke,
came off, etc.) in an incident situation.
Rationale for Obtaining Investigations
The goal of this project is to collect information to assist CPSC staff in making recommendations to update
voluntary standards for helmets worn during contact sports and to update CPSC’s information campaign. We are
interested in trying to reduce the number of sports helmet related deaths and injuries during youth contact sports
while helmets are being worn by the victims. Reducing head injuries to children is one of the Commission's stated
objectives under the Government Performance and Results Act.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Emerging Hazards

Emerging Hazards, General (HANN01)
CATEGORY ID: HANN01
CATID Owner: Risana Chowdhury

EPHA Analyst:
Program/Project Lead:

Risana Chowdhury, EPHA, 301-504-7334, rchowdhury@cpsc.gov
Patricia Adair, EXHR, 301-504-7335, padair@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Headquarters will assign emerging hazard incidents involving fatalities or injuries that are not covered by other
categories of the Criteria and Rationales.
Telephone or on-site investigations may be requested for high visibility cases. An assignment message will be
written specifically for the incident/product.
Rationale for Obtaining Investigations
Investigations will be assigned by headquarters’ staff when analyses of incoming reports suggest an emerging trend.
These investigations may be motivated by either product type or hazard type. As injury or fatality reports increase
with new or modified products that are not covered elsewhere in the Criteria and Rationale documents,
investigations specific to the injury scenario, engineering and safety features, and human factors will be assigned.
Examples of investigations that may be assigned across products include emerging trends associated with imported
goods or trends that are suggested by specific hazard types.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Emerging Hazards

Nano and Emerging Materials (HANN02)
CATEGORY ID: HANN02
CATID Owner: Treye Thomas

EPHA Analyst:
Angie Qin, EPHA, 301-504-7810, aqin@cpsc.gov
Technical contacts:
Nanotechnology contact: Joanna Matheson, HSTR, 301-987-2564, JMatheson@cpsc.gov
Emerging Materials (incl. 3D printing): Treye Thomas, EXHR, 301-987-2560, TThomas@cpsc.gov
Compliance contact:
Stephanee Synnott, CRE, 301-504-7847, SSynnott@cpsc.gov
Criteria for Assigning Non-NEISS Investigations
Incidents involving nanomaterials or emerging materials used in and released from consumer products are of
particular interest to staff. Emerging materials are compounds used in the 3D printing of consumer products either
by a manufacturer or by a consumer with their own 3D printing device. Examples of emerging materials used in 3D
printers include thermoplastic filaments such as poly lactic acid (PLA), metal-containing powders, and liquid
polymers. Nanomaterials (e.g., carbon nanotubes, nano silver, titanium dioxide, graphene, zinc oxide) are defined as
materials/particles that range from 1 to 100 nanometers in length. Although they may have the same name as a
material currently in use, because of their small size, these new materials may demonstrate different physical and
chemical properties. Nanomaterials are being used in consumer products with the stated purpose of improving the
performance and durability of these products (e.g., sporting goods, clothing, cleaners, toys, paints/coatings, home
furnishings, electronics (including 3D printer filaments)).
Incidents can be assigned by headquarters staff, or by field staff in consultation with headquarters staff. A specific
questionnaire may be available to investigate certain products. If there is a specific questionnaire, the assignment
message will direct the investigator to contact the analyst to obtain any such questionnaire prior to initiating an
investigation. If there are any questions during an investigation, the field investigator should contact the person(s) at
headquarters listed above as points-of contact for the specific product area.
Rationale for Obtaining Investigations
Information on the circumstances of chemical hazard incidents due to exposure to nanomaterials and/or emerging
materials in consumer products is needed to support work under the Federal Hazardous Substance Act (FHSA) and
the Consumer Product Safety Act (CPSA). While a great deal of resources have been devoted to developing these
technologies, much less has been on understanding health and safety. Nanomaterials represent a wide range of
compounds that may vary significantly in their structure, physical and chemical properties, as well as potentially in
their behavior in the environment and human body. Details on deaths and adverse health effects involving a wide
range of consumer products that contain nanomaterials and emerging materials, are needed to support work under
the Commission’s toxicity assessment portion of the Chemical Hazards Project. Investigations will be used to
evaluate voluntary standards to reduce the risk of injury resulting from exposures to emerging materials incorporated
in and released from consumer products.

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Criteria and Rationales for Field-Initiated In-Depth Investigations – FY 2020

Emerging Hazards

Wearable Technology Products (HANN02)
CATEGORY ID: HANN02
CATID Owner: Treye Thomas

EPHA Analyst:
Wearable technology contact:
Compliance contact:

Angie Qin, EPHA, 301-504-7810, aqin@cpsc.gov
Treye Thomas, EXHR, 301-987-2560, TThomas@cpsc.gov
Stephanee Synnott, CRE, 301-504-7847, SSynnott@cpsc.gov

Criteria for Assigning Non-NEISS Investigations
Headquarters staff will periodically make assignments. Incidents involving wearable technology products are of
particular interest to staff. Wearable technology products are also known as “smart products.” They are consumer
products that are worn on the body which contain electronic components. Examples include smart clothing with
sensors, virtual reality game sets, fitness trackers and glasses that augment reality.
Incidents can be assigned by headquarters staff or field staff in consultation with headquarters staff. A specific
questionnaire may be available to investigate certain products. If there is a specific questionnaire, the assignment
message will direct the investigator to contact the analyst to obtain any such questionnaire prior to initiating an
investigation. If there are any questions during an investigation, the field investigator should contact the person(s) at
headquarters listed above as point-of contact for the specific product area.
Rationale for Obtaining Investigations
Information on the circumstances of chemical hazard incidents due to wearable technology products is needed to
support work under the Federal Hazardous Substance Act (FHSA) and the Consumer Product Safety Act (CPSA).
Details on deaths and adverse health effects involving a wide range of consumer products that fall under the
category of wearable technology, are needed to support work under the Commission’s toxicity assessment portion of
the Chemical Hazards Project as well as electrical, mechanical and internet of things (IOT) programs. Investigations
will be used to evaluate voluntary standards to reduce the risk of injury resulting from exposures to hazards resulting
from the use of wearable technology products.

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