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pdfINCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Fireworks Devices
DOCUMENT NUMBER:
DATE OF INCIDENT:
FOLLOW-UP REQUESTED
CATID: CARM02 2020
HAZARD ANALYSIS
COMPLIANCE
PRIMARY CONTACT: Shawn Keller, CRE, 301-504-7122, SDKeller@cpsc.gov
BACK-UP CONTACTS: Yongling Tu, EPHA, 301-504-7841, ytu@cpsc.gov
ASSIGNMENT MESSAGE:
Conduct an IDI on any incidents involving any fireworks device(s) resulting in deaths or serious injuries.
Serious injuries are defined as injuries requiring admission to the hospital for medical treatment. Also
conduct an IDI on any of the following types of incidents, even if no injuries are involved:
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that involve large, illegal firecracker type devices such as M-80’s, M-100’s, M-1000’s, “quarter” of
“half” sticks, silver salutes, tennis or ping pong ball “bombs”, etc.
that involve 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), including fireworks made from components obtained via the Internet or mail order
that involve professional (1.3G, UN0335, formerly Class B) fireworks that were sold to or used by a
consumer
that involve devices known as “pest control” devices that are used by consumers for purposes other
than pest control.
If the incident involved serious injury or death, then obtain information describing the accident scenario
and the person(s) involved. For all incidents obtain product description and as much product information
as possible (i.e., product name and model number, name and address of manufacturer, importer and
retailer). Determine who purchased the device and who gave it to victim to use (if victim did not purchase
it). Determine the victim's experience using fireworks and whether there was adult supervision at the time
of the incident.
Check with the headquarters contact before assigning incidents involving injuries from consumer
fireworks.
If the product involved was an illegal explosive device (M-80, Cherry Bomb, etc.), or involved chemicals
or components, or pest control devices, determine how victim obtained the device and the identification
of the supplier.
If the product involved was identified as a 1.3G/UN0335 (professional) fireworks device, determine if the
incident occurred during a professional public display and whether the victim was a bystander or an
operator. Do not assign cases involving operators (even when volunteers), without checking with the
headquarters contact.
CPSC FORM 324A
In cases of an incident involving the consumer sale or seizure of display fireworks or illegal flash powder
devices, notify the headquarters contact IMMEDIATELY. These investigations frequently result in
criminal charges and special steps and procedures must be followed. Do not wait for the completion and
forwarding of an IDI report to discuss the case with the headquarters contact.
Obtain photographs of the incident scene and product(s) involved, if available. Obtain copies of any
official investigation reports and other documents, if available.
Please include all primary and all backup contacts in the distribution of the completed IDI.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Area below will be completed in Data Systems _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Person(s) to Contact:
Guidelines:
Task Number:
Assigned to:
CPSC FORM 324A
Appendix 109
Date:
Processed by: lew
File Type | application/pdf |
File Title | ACCIDENT INVESTIGATION REQUEST FORM |
Author | Preferred Customer |
File Modified | 2019-11-07 |
File Created | 2019-11-07 |