Television tipover guidelines

NEISS TV Tipovers for Children Younger than Five
Questionnaire # ________ (1-4)

Q.1 Interviewer: Instructions to the interviewer are in bold blue text.

Please do not read "Don't Known/Unknown" choices unless instructed to
read the choices.
Please do not read "Refused" choice on any question.
The purpose of this study is to investigate TV tipovers for children younger
than five years of age and determine:
What types of TVs are falling?
Are we seeing more of the newly designed digital TVs falling?
Why are the TVs falling?
What is the interaction between the child and TV?
There will be a report written summarizing the results at the end of the study.
Kevin Gipson, CPSC, EPHA
[email protected]
301-504-7415
Sections:
Questions
Q4
- Q9
Q11 - Q24
Q26 - Q40
Q42 - Q55
Q57 - Q68
Q70 - Q79
Q.2 Interviewer:

Section
Contact Questions
TV Tipover Scenario Questions
TV Specific Questions
TV Placement/Mount Questions
Furniture Questions
General TV Tipover Questions

Please enter Task Number

____________________________________________________________________________

OMB Control Number 3041-0029

(5-17)

Q.3

Contact Questions

Q.4 Hello, may I speak with the parent or guardian of __________?

I'm calling for the Consumer Product Safety Commission. We are presently
performing a study on childhood television tipovers. I understand that (Victim's
Name) was in an accident involving a television and would like to ask you some
questions about the accident.
Interviewer:
Be prepared to answer/assure with the following:
- that the identity will be kept confidential
- that the purpose of the study is to prevent future incidents and injuries
- there is a particular interest in the circumstances surrounding the
childhood TV tipover
(18)

q1
q2

Agreed
Refused

[S - IF THE ANSWER IS 2, THEN SKIP TO QUESTION 80]

Q.5 Do you know how this incident happened?
[REQUIRE ANSWER]
(19)

q1
q2
q3

Yes
No
Refused

[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 11]

Q.6 Is there someone else who knows more about the details of the incident?
[REQUIRE ANSWER]
(20)

q1
q2
q3
[S - IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 80]

OMB Control Number 3041-0029

Yes
No
Refused

Q.7 Is he/she available?
[REQUIRE ANSWER]
(21)

q1
q2
q3

Yes
No
Refused

[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 4]
[S - IF THE ANSWER IS 3, THEN SKIP TO QUESTION 80]

Q.8 Record name and phone number if different.
___________________________________________________________________________

(22-71)

Q.9 When would be a good time to contact him/her?
[REQUIRE ANSWER]
__________________________________________________________________________

(72-121)

[D - IF THE ANSWER TO QUESTION 7 IS 2, THEN SKIP TO QUESTION 80]

Q.10

TV Tipover Scenario Questions

Q.11 Please give a brief summary of the reason for the emergency room visit.

Interviewer: Please probe for the following information if they fail to
mention it in their summary
- TV involvement in incident or injury
- Prompt for injury and treatment given
- Specify the primary body part injured
[REQUIRE ANSWER]
________________________________________________________________________

(122-1121)

Q.12 Interviewer: If the incident did not involve a television, end the interview.
[REQUIRE ANSWER]
(1122)

q1
q2
[S - IF THE ANSWER IS 2, THEN SKIP TO QUESTION 79]

OMB Control Number 3041-0029

Continue
End the Interview

Q.13 What was the child doing prior to the incident?
[REQUIRE ANSWER]
_______________________________________________________________________

(1123-1372)

Q.14 In what condition was the child found, after the TV fell?

Interviewer: Please probe for items such as
- Who found the child?
- Were they found under items such as the TV or
furniture?
[REQUIRE ANSWER]
_______________________________________________________________________

(1373-1622)

Q.15 What happened after the child was found?

Interviewer: Please probe for items such as
- Was child treated at home first?
- How long before child taken to the emergency
room?
[REQUIRE ANSWER]
_______________________________________________________________________

(1623-1872)

Q.16 Were any other children present when the incident occurred?

Interviewer: We are interested in finding out about children in the same
room as victim during the TV falling.
[REQUIRE ANSWER]
(1873)

q1
q2
q3
q4
[S - IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 18]

OMB Control Number 3041-0029

Yes
No
Don't know
Refused

Q.17 What relationship were the other children to (name of victim) ?

Interviewer: Probe for ages of other children.
[REQUIRE ANSWER]
_______________________________________________________________________

(1874-2123)

Q.18 What fell?

Interviewer:
What items/objects fell/tipped over during the incident. We are interested
in finding out what fell.
Instruction: Read choices except for Refused. Item did not have to strike
the child.
[REQUIRE ANSWER]
(2124)

q1
q2
q3
q4
q5

Television only
Television and furniture (other items could have fallen as well)
Television and other items (no furniture fell)
Television did not fall (End the interview)
Refused (End the interview)

[S - IF THE ANSWER IS 1 OR 2, THEN SKIP TO QUESTION 20]
[S - IF THE ANSWER IS 4 OR 5, THEN SKIP TO QUESTION 79]

Q.19 Please describe what other items fell?
[REQUIRE ANSWER]
_______________________________________________________________________

OMB Control Number 3041-0029

(2125-2374)

Q.20 Which best describes the interaction of the child with the TV or furniture right

before the TV or furniture fell?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(2375)

q1
q2
q3
q4
q5
q6
q7
q8

Climbing on the TV or furniture
Pulling on the TV or furniture
Pushing on the TV or furniture
Pulling on Cords or Wires Attached to TV
Did not touch or interact with TV or furniture
Other interaction with TV or furniture
Don't Know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 5 OR 7 OR 8, THEN SKIP TO QUESTION 22]

Q.21 Please describe how the child interacted with the TV or furniture.
[REQUIRE ANSWER]
_______________________________________________________________________

(2376-2625)

Q.22 Did anyone else touch or interact with the TV or furniture right before the TV or

furniture fell?

[REQUIRE ANSWER]
(2626)

q1
q2
q3
q4

Yes
No
Don't Know
Refused

[S - IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 26]

Q.23 Which best describes the interaction with the other person and the TV or

furniture right before the TV or furniture fell?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(2627)

q1
q2
q3
q4
q5
q6
q7

Climbing on the TV or furniture
Pulling on the TV or furniture
Pushing on the TV or furniture
Pulling on Cords or Wires Attached to TV
Other interaction with the TV or furniture
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 6 OR 7, THEN SKIP TO QUESTION 26]
OMB Control Number 3041-0029

Q.24 Please describe how the other person interacted with the TV or furniture.
[REQUIRE ANSWER]
_______________________________________________________________________

Q.25

(2628-2877)

TV Specific Questions

Q.26 What type of television was involved in the incident?

Instruction: Read choices except for Refused.
Interviewer:
Flat screen deals with the curvature of the screen whereas newer flat panel
deals with the depth of the TV.
TUBE - CRT can also be flat screen, older TVs usually CRT.
Flat panel - usually the newer tvs which are thin in depth.
[REQUIRE ANSWER]
(2878)

q1
q2
q3
q4
q5
q6

Tube (CRT)
Flat panel (plasma, LCD)
Projection (rear projection)
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 5 OR 6, THEN SKIP TO QUESTION 28]

Q.27 Please describe the "other" type of television.
[REQUIRE ANSWER]
_______________________________________________________________________

(2879-3128)

Q.28 What is the approximate screen size (measured diagonally) of the TV involved

in incident? Please specify units.

Interviewer: Height and width if the diagonal measurement is unknown.
[REQUIRE ANSWER]
_______________________________________________________________________

OMB Control Number 3041-0029

(3129-3178)

Q.29 What is the approximate depth of the TV from the front of the screen to the back

of the TV?

Interviewer: Don't read choices unless respondent is unsure, then
interviewer could prompt. Don't read the refused choice.
[REQUIRE ANSWER]
(3179)

q1
q2
q3
q4
q5
q6

Less than 6 Inches
6 inches to Less 12 inches
12 inches (1 Ft) to Less than 24 inches (2 Ft)
More than 24 Inches (2 Ft)
Don't Know
Refused

Q.30 What type of signal does the TV receive?

Interviewer: This is the signal the TV receives without any type of
converter box.
[REQUIRE ANSWER]
(3180)

q1
q2
q3
q4

Analog
Digital
Don't Know
Refused

Q.31 What is the name brand of the TV involved in the incident?
[REQUIRE ANSWER]
_______________________________________________________________________

(3181-3230)

Q.32 What is the Model and Model number?
[REQUIRE ANSWER]
_______________________________________________________________________

OMB Control Number 3041-0029

(3231-3280)

Q.33 What is the approximate age of the TV?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(3281)

q1
q2
q3
q4
q5
q6

New or less than 1 year old
1 to less than 5 years old
5 to less than 10 years old
10 years or more
Don't know
Refused

Q.34 Which of the following best describes the base of the TV?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(3282)

q1
q2
q3
q4
q5

Built-in swivel base (moves, turns)
Stationary Base (does not move)
Other
Don't Know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 4 OR 5, THEN SKIP TO QUESTION 36]

Q.35 Please describe the "other" type of base.
[REQUIRE ANSWER]
_______________________________________________________________________

(3283-3382)

Q.36 Did the base of the TV itself break or fail in some way?

Interviewer: Asking about the base of the TV itself and not about a
wall-mount or furniture breaking.
[REQUIRE ANSWER]
(3383)

q1
q2
q3
q4
[S - IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 38]

OMB Control Number 3041-0029

Yes
No
Don't know
Refused

Q.37 Please describe how the base of the TV broke or failed.
[REQUIRE ANSWER]
_______________________________________________________________________

(3384-3633)

Q.38 Which location describes where the TV was located at the time of the incident?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(3634)

q1
q2
q3
q4
q5
q6
q7

Living room or Family room or Den
Bedroom
Kitchen
Dining room
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 6 OR 7, THEN SKIP TO QUESTION 40]

Q.39 Please describe the "other" location.
[REQUIRE ANSWER]
_______________________________________________________________________

(3635-3734)

Q.40 About how high was the television positioned measured from the floor to the

bottom of the television? Please specify units of measurement.
[REQUIRE ANSWER]
_______________________________________________________________________

Q.41

TV Placement/Mount Questions

OMB Control Number 3041-0029

(3735-3784)

Q.42 Which describes the placement of the TV in the room prior to the incident?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(3785)

q1
q2
q3
q4
q5

Freestanding (inside or on furniture, on the floor or countertop)
Wall-mounted (on the wall or some type of mount)
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 4 OR 5, THEN SKIP TO QUESTION 44]
[S - IF THE ANSWER IS 2, THEN SKIP TO QUESTION 49]

Q.43 Please describe the "other" type of placement.
[REQUIRE ANSWER]
_______________________________________________________________________

(3786-4035)

Q.44 Prior to the incident was the TV

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(4036)

q1
q2
q3
q4
q5
q6
q7

Inside of furniture (such as an entertainment center, cabinet, etc.)
On top of furniture (such as a tv stand, dresser, etc.)
On the floor
On a countertop
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2, THEN SKIP TO QUESTION 57]
[S - IF THE ANSWER IS 3, THEN SKIP TO QUESTION 70]
[S - IF THE ANSWER IS 4, THEN SKIP TO QUESTION 47]
[S - IF THE ANSWER IS 6 OR 7, THEN SKIP TO QUESTION 72]

OMB Control Number 3041-0029

Q.45 Please describe other.
[REQUIRE ANSWER]
_______________________________________________________________________

(4037-4286)

Q.46 Interviewer: Was the "other" a type of furniture?
[REQUIRE ANSWER]
(4287)

q1
q2

Yes (go to furniture section)
No

[S - IF THE ANSWER IS 1, THEN SKIP TO QUESTION 57]

Q.47 Did the item the TV was in or on break or fail in some way?
[REQUIRE ANSWER]
(4288)

q1
q2
q3
q4

Yes
No
Don't know
Refused

[S - IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 72]

Q.48 Please describe how it broke or failed.
[REQUIRE ANSWER]
_______________________________________________________________________

(4289-4538)

[D - IF THE ANSWER TO QUESTION 47 IS 1, THEN SKIP TO QUESTION 72]

Q.49 Before the incident, what type of wall mount was the TV attached to

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(4539)

q1
q2
q3
q4
q5
q6
q7

Fixed against the wall (does not tilt, extend or articulate from wall)
Against the wall but can swivel and tilt from wall
Fixed shelf attached to wall (does not swivel)
Swivel shelf attached to wall (angle can be adjusted)
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 6 OR 7, THEN SKIP TO QUESTION 51]

OMB Control Number 3041-0029

Q.50 Please describe the "other" type of wall mount.
[REQUIRE ANSWER]
_______________________________________________________________________

(4540-4789)

Q.51 Please specify the brand name of the wall mount.

Interviewer: If brand name is unknown, where purchased? Please state
"purchased at (retailer)" in answer.
[REQUIRE ANSWER]
_______________________________________________________________________

(4790-5039)

Q.52 What type of material is the mount made from?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(5040)

q1
q2
q3
q4
q5
q6
q7

All Metal
All Plastic
Combination of Metal and Plastic
Wood
Other
Don't Know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 6 OR 7, THEN SKIP TO QUESTION 54]

Q.53 Please describe the "other" type of material mount made from.
[REQUIRE ANSWER]
_______________________________________________________________________

(5041-5290)

Q.54 Did the mount break or fail in some way?
[REQUIRE ANSWER]
(5291)

q1
q2
q3
q4
[S - IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 72]

OMB Control Number 3041-0029

Yes
No
Don't know
Refused

Q.55 How did it break or fail?
[REQUIRE ANSWER]
_______________________________________________________________________

(5292-5541)

[D - IF THE ANSWER TO QUESTION 54 IS 1, THEN SKIP TO QUESTION 72]

Q.56

Furniture Questions

Q.57 What type of furniture was the TV placed in or on during the incident?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(5542)

q1
q2
q3
q4
q5
q6
q7

Entertainment Center
TV stand or cart
Dresser or Chest of Drawers or Bureau
Shelving or Bookcase or Cabinet
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 6 OR 7, THEN SKIP TO QUESTION 59]

Q.58 Please describe the "other" type of furniture.
[REQUIRE ANSWER]
_______________________________________________________________________

(5543-5792)

Q.59 What is the brand name of the furniture?

Interviewer: If brand name is unknown, where purchased? Please state
"purchased at (retailer)" in answer.
[REQUIRE ANSWER]
_______________________________________________________________________

(5793-5842)

Q.60 What is the model and model number?
[REQUIRE ANSWER]
_______________________________________________________________________

OMB Control Number 3041-0029

(5843-5892)

Q.61 Was the furniture stationary or can it move due to having wheels?
[REQUIRE ANSWER]
(5893)

q1
q2
q3
q4
q5

Stationary
Wheels
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 4 OR 5, THEN SKIP TO QUESTION 63]

Q.62 Please describe the "other" type of movement of the furniture.
[REQUIRE ANSWER]
_______________________________________________________________________

(5894-6143)

Q.63 Did the furniture fail or break in some way?
[REQUIRE ANSWER]
(6144)

q1
q2
q3
q4

Yes
No
Don't know
Refused

[S - IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 65]

Q.64 How did the furniture break or fail?
[REQUIRE ANSWER]
_______________________________________________________________________

OMB Control Number 3041-0029

(6145-6394)

Q.65 What type of surface was the furniture on?

Instruction: Read choices except for Refused.
[REQUIRE ANSWER]
(6395)

q1
q2
q3
q4
q5
q6
q7
q8
q9

Carpeting
Hardwood
Tile
Lineoleum
Rug on carpet
Rug on hard surface (hardwood, tile, or lineoleum)
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 8 OR 9, THEN SKIP TO QUESTION 67]

Q.66 Please describe the "other" type of surface the furniture was on.
[REQUIRE ANSWER]
_______________________________________________________________________ (6396-6495)

Q.67 Were there any anti-tipping or safety devices as part of the television or installed

with the furniture?

[REQUIRE ANSWER]
(6496)

q1
q2
q3
q4

Yes
No
Don't know
Refused

[S - IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 74]

Q.68 Please describe the types of devices installed?
[REQUIRE ANSWER]
_______________________________________________________________________
[D - IF THE ANSWER TO QUESTION 67 IS 1, THEN SKIP TO QUESTION 74]

Q.69

General TV Tipover Questions

OMB Control Number 3041-0029

(6497-6746)

Q.70 What type of surface was the TV on?

Instruction: Read choices except for Refused.
(6747)

q1
q2
q3
q4
q5
q6
q7
q8
q9

Carpeting
Hardwood
Tile
Lineoleum
Rug on carpet
Rug on hard surface (hardwood, tile, or lineoleum)
Other
Don't know
Refused

[S - IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 8 OR 9, THEN SKIP TO QUESTION 72]

Q.71 Please describe the "other" type of surface the TV was on.
_______________________________________________________________________

(6748-6847)

Q.72 Was there any anti-tipping or safety devices as part of the television?
[REQUIRE ANSWER]
(6848)

q1
q2
q3
q4

Yes
No
Don't Know
Refused

[S - IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 74]

Q.73 Please describe the types of devices installed.
[REQUIRE ANSWER]
_______________________________________________________________________

(6849-7098)

Q.74 Have there been any other incidents with this TV tipping or falling? If so, please

describe briefly how many incidents and what happened in each incident.
[REQUIRE ANSWER]
_______________________________________________________________________

OMB Control Number 3041-0029

(7099-8098)

Q.75 Is there anything else about the incident that the CPSC should know about?
_______________________________________________________________________

Q.76 I'm now going to ask some information about

What was

(Victim's Name)

(8099-9098)

(Victim's Name)

.

's age at the time of the accident?

Interviewer: If any age < 3 years, prompt for the age in months. Don't
read choices unless respondent is unsure, then interviewer could prompt.
Don't read the refused choice.
[REQUIRE ANSWER]
(9099)

q1
q2
q3
q4
q5
q6
q7
q8
q9
q0

Q.77 How long was

accident?

(Victim's Name)

less than 6 months old
6 to 11 months old
12 to 17 months old
18 to 23 months old
24 to 29 months old
30 to 35 months old
3 yrs to less than 4 yrs old
4 yrs old
Don't know
Refused

under medical care specifically after the

Interviewer: Probe for whether they were hospitalized, required
rehabilitation, or periodic check-ups/follow-up visits.
[REQUIRE ANSWER]
_______________________________________________________________________

Q.78 What is the long term medical outlook for

(Victim's Name)

(9100-9599)

?

[REQUIRE ANSWER]
_______________________________________________________________________

OMB Control Number 3041-0029

(9600-9849)

Q.79 On behalf of the Consumer Product Safety Commission, I would like to thank you

for your cooperation during this interview. If we need to follow-up on this interview,
would it be alright for us to get back in touch with you?
[REQUIRE ANSWER]
(9850)

q1
q2
q3

Yes
No
Refused

Q.80 Thank you for your time.

Interviewer: End Interview
Q.81 Interviewer: What is the date this interview was completed (MMDDYY)?
MMDDYY ............ ____________ (9851-9856)

OMB Control Number 3041-0029