SECTAB - multi-cooker

SECTAB - multi-cooker.pdf

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

SECTAB - multi-cooker

OMB: 3041-0029

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INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Compliance Multi-Cooker Incident Assignments – SECTAB2020
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID:

FOLLOW-UP REQUESTED
PRIMARY CONTACT:
BACK-UP CONTACT:

HAZARD ANALYSIS

SECT 15

Carolina Abraham, 301-504-7603, CAbraham@cpsc.gov

ASSIGNMENT MESSAGE:
Please investigate the attached

fatal

non-fatal incident involving a

[general name of product]

This assignment is to be completed as
on-site investigation
telephone investigation
on-site investigation if sample available, otherwise telephone investigation
Priority level:

AA

BB

CC

Justification for AA or BB priority:
STATE in which incident occurred:
Incident and/or exemplar sample collection for Commission evaluation:
Yes, obtain entire incident product, if available
Yes, obtain part of incident product []
Obtain [] exemplar(s).
No sample collection necessary

Note: only one sample collection box above can by marked in the system – please see Instructions to Investigator section below for additional sample collection information, if applicable.

Instructions to Investigator:

(Note: if specialized instructions ARE included here but appear to be incomplete, contact the requestor for additional guidance.)

Attempt to obtain as much detail as possible about the cooking process. Specifically, what was cooked, who put on the
lid, how many times had they previously put on the lid, how did they put the lid on (one hand or two), how do they
know the lid was on correctly and locked, did it make a noise while cooking, how long did it cook (how far into the
cooking process), what setting was used, did it vent steam, was it touched before the lid came off (if so how), how was
the lid removed (with one hand or two)? Also, did the person read the manual? Obtain photos, medical records, and
communications with the Firm.
Obtain all official reports.
Verify incident scenario. Provide complete product identification including: manufacturer, brand, date
manufactured, place of purchase, date of purchase, model/serial numbers, cost, etc.
Please include primary and any backup contacts in the distribution of the completed IDI.
Please refer to any/all applicable guidelines and data record sheets.
If this assignment is requested by Compliance but is listed as a category in the Criteria and Rationales, then the report should also
meet the requirements of the Criteria and Rationales including use of any applicable guidelines and data record sheets. For
assignments requested by EP, if it is clear that a product defect is involved, then the report must also meet Compliance requirements.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Area below will be completed in Data Systems _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Person(s) to Contact:
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew


File Typeapplication/pdf
File TitleACCIDENT INVESTIGATION REQUEST FORM
AuthorPreferred Customer
File Modified2019-09-13
File Created2019-09-13

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