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pdfINCIDENT 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 Type | application/pdf |
File Title | ACCIDENT INVESTIGATION REQUEST FORM |
Author | Preferred Customer |
File Modified | 2019-09-13 |
File Created | 2019-09-13 |