CARM13 Compliance NFIRS Cases

CARM13 Compliance NFIRS Cases.pdf

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

CARM13 Compliance NFIRS Cases

OMB: 3041-0029

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INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Compliance NFIRS Case
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID: CARM13 2020

FOLLOW-UP REQUESTED

HAZARD ANALYSIS

COMPLIANCE

PRIMARY CONTACT: Joe Williams, CEL, 301-504-7585, JFWilliams@cpsc.gov
BACKUP CONTACT: David Miller, EPHA, 301-504-7323, dmiller@cpsc.gov

ASSIGNMENT MESSAGE:
This investigation involves an NFIRS report incident where we are interested in reaching out to the consumer. For
any questions regarding this IDI, please contact Joe Williams.
Please investigate this incident as a telephone IDI. Collect all necessary information as specified below. If the
consumer is not responsive, a full narrative write up for this IDI will not be necessary. If the consumer is
responsive, include a full narrative write up, including usage history and event details.
Search for consumer information based on address and contact the consumer to get more information about the
product, purchase details, product use history, and the events leading to and details of the product failure and
subsequent damage or injury.
Collect photos of the product and incident.
If the incident product is available for collection, contact the Compliance Officer to determine if sample collection is
desired.
Refer to any/all applicable guidelines for the involved product(s) in order to collect additional relevant information.
Complete any/all applicable data record sheets. If the incident involves Internet of Things (IoT)/Connected
Products, complete the DRS found in Appendix 140.
Contact the Fire Department for a copy of any reports they may have for the incident. The Fire Department ID is
listed in the source document as the “Manufacturer Date Code.” The Fire Department can be identified by the
FDID list which can be downloaded here: https://apps.usfa.fema.gov/registry/main/download.
Contact other relevant government entities to collect reports (e.g. police, fire marshal, etc.)

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: All relevant guidelines, including, but not limited to:
Appendix 140 – Internet of Things (IoT)/Connected Products
Appendix 128 – Smoke Alarms
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew


File Typeapplication/pdf
File TitleACCIDENT INVESTIGATION REQUEST FORM
AuthorPreferred Customer
File Modified2020-02-06
File Created2020-02-06

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