Follow-Up Activities for Product-Related Injuries-Interviews

Submersion Incidents Children Under 5

Questionnaire # ________ (1-4)

Q.1 Please enter Task Number
__________________________

(5-17)

Q.2 Hello, may I speak with the parent or guardian of __________?
I'm calling for the Consumer Product Safety Commission. I understand that (Victim's Name) had a
submersion or drowning accident. We are presently performing a study on childhood submersions
and near drownings and would like to ask you some questions about the accident.
Be prepared to answer questions with the following information:
- 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 submersion or near
drowning
(18)

Agreed ... 1
Refused .. 2
[IF THE ANSWER IS 2, THEN SKIP TO QUESTION 178]

Q.3 Are you familiar with how this incident happened?
(19)

Yes . 1
No ... 2
[IF THE ANSWER IS 1, THEN SKIP TO QUESTION 8]

Q.4 Is there someone else who is more familiar with the details of the incident?
(20)

Yes . 1
No ... 2
[IF THE ANSWER IS 2, THEN SKIP TO QUESTION 178]

Q.5 May I speak with him/her?
(21)

Yes . 1
No ... 2
[IF THE ANSWER IS 1, THEN SKIP TO QUESTION 2]

Q.6 Record name and phone number if different
___________________________________________________________________________________

(22-71)

Q.7 When would be a good time to contact him/her?
__________________________________________________

(72-96)

[IF THE ANSWER TO QUESTION 5 IS 2, THEN SKIP TO QUESTION 178]

Q.8 I understand that (Victim's Name) was treated at the emergency room on (date) following a
submersion or near drowning accident. Is that correct?
(97)

Yes . 1
No ... 2
[IF THE ANSWER IS 1, THEN SKIP TO QUESTION 11]

Q.9 Please give a brief summary of the reason for the emergency room visit.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

-2-

(98-597)

Q.10 If the incident did not involve a submersion incident, end the interview.
(598)

End the interview .. 1
Continue ............... 2
[IF THE ANSWER IS 1, THEN SKIP TO QUESTION 177]

Q.11 What was the child doing prior to the incident?
_________________________________________________________________________________

(599-848)

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

Q.12 Where was the child before the incident?
________________________________________________________________________________

(849-1098)

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Q.13 How did the child get to the water source?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

-3-

(1099-1348)

Q.14 How was the child found?
_______________________________________________________________________________

(1349-1598)

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Q.15 What happened after the child was found?
_______________________________________________________________________________

(1599-1848)

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Q.16 Were any other children involved in the incident?
(1849)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 18]

Q.17 What relationship were the other children to (name of victim) ?
Interviewer: Probe for ages of other children.
_______________________________________________________________________________
_______________________________________________________________________________

-4-

(1850-1949)

Q.18 What day of the week and time did the incident occur?
_______________________________________________________________________________

(1950-2049)

_______________________________________________________________________________

Q.19 Is there anything else about the incident that the CPSC should know about?
_______________________________________________________________________________

(2050-2299)

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Q.20 Given the the description you just gave me, some of the following questions may seem repetitive
and I apologize for that. We're just trying to answer some important questions to improve product
safety and your help with these questions will be greatly appreciated.
Please read responses to questions to allow respondent to hear all possible answers. Please DO
NOT read the Don't Know responses. Use this only if offered by the respondent.

-5-

Q.21 I'm going to read a list of products, please indicate the product that was involved in the accident.
Was it a:
(2300)

Swimming pool (includes all types of pools) .......
Bucket .................................................................
Spa or hot tub .....................................................
Bathtub (includes baby bathtubs & bathinettes) .
Toilet ...................................................................
Pond ...................................................................
Other ..................................................................

1
2
3
4
5
6
7

[IF THE ANSWER IS 1, THEN SKIP TO QUESTION 23]
[IF THE ANSWER IS 2, THEN SKIP TO QUESTION 90]
[IF THE ANSWER IS 3, THEN SKIP TO QUESTION 100]
[IF THE ANSWER IS 4, THEN SKIP TO QUESTION 113]
[IF THE ANSWER IS 5, THEN SKIP TO QUESTION 130]
[IF THE ANSWER IS 6, THEN SKIP TO QUESTION 136]

Q.22 Please describe the Other product involved.
_______________________________________________________________________________
_______________________________________________________________________________

[IF THE ANSWER TO QUESTION 21 IS 7, THEN SKIP TO QUESTION 147]

Q.23 What type of swimming pool was involved?
(2401)

In-ground pool ........
Above-ground pool .
On-ground pool .......
Inflatable pool .........
Wading pool ...........

1
2
3
4
5

Q.24 Where is the location of the pool?
(2402)

Own residence ....................
Other person's residence ....
Recreational or public area .
Other ...................................

1
2
3
4

[IF THE ANSWER IS 1 OR 2 OR 3, THEN SKIP TO QUESTION 26]

-6-

(2301-2400)

Q.25 Please describe the Other location of the pool.
_______________________________________________________________________________

(2403-2502)

_______________________________________________________________________________

[IF THE ANSWER TO QUESTION 23 IS 5, THEN SKIP TO QUESTION 75]
[IF THE ANSWER TO QUESTION 23 IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 54]
[IF THE ANSWER TO QUESTION 24 IS 1 OR 2, THEN SKIP TO QUESTION 27]

Q.26 Was a lifeguard on duty at the pool?
(2503)

Yes ............. 1
No .............. 2
Don't know . 3

Q.27 Did

(Victim's Name)

have permission to be in the area of the pool?
(2504)

Yes ............. 1
No .............. 2
Don't know . 3

Q.28 Was the child using any type of swimming product, for instance water wings, noodles, inner tubes?
(2505)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 30]

Q.29 Please describe the type of swimming product the child was using.
_______________________________________________________________________________
_______________________________________________________________________________

-7-

(2506-2605)

Q.30 Were you able to see the bottom of the pool on the day of the accident?
(2606)

Yes ............. 1
No .............. 2
Don't know . 3

Q.31 Prior to the accident, had the child ever had any type of formal water instruction? This could include
water familiarity classes, water safety, beginner swimming lessons or other types of lessons?
(2607)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 33]

Q.32 Please describe the type of water instruction the child had received including where the classes
were taken, the nature of the skills taught and the approximate number of classes taken.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

-8-

(2608-3107)

Q.33 Was the pool an indoor pool or an outdoor pool?
(3108)

Indoor Pool .... 1
Outdoor Pool .. 2
[IF THE ANSWER IS 2, THEN SKIP TO QUESTION 41]

Q.34 How did

(Victim's Name)

get into the area of the indoor pool?
(3109)

Open door ....
Cosed door ..
Open gate ....
Closed gate ..
Don't know ...
Other ............

1
2
3
4
5
6

[IF THE ANSWER IS 1 OR 3 OR 5, THEN SKIP TO QUESTION 39]
[IF THE ANSWER IS 2 OR 4, THEN SKIP TO QUESTION 36]

Q.35 Please describe how

(Victim's Name)

got into the area of the indoor pool.

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Q.36 Was there an alarm on the closed door/gate?
(3410)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 39]

-9-

(3110-3409)

Q.37 Please describe the alarm on the door/gate.
_______________________________________________________________________________
_______________________________________________________________________________

Q.38 Was the alarm on the door/gate activated and working at the time of the accident?
(3511)

Working and activated ..........
Working but not activated .....
Activated but not working ......
Neither working or activated .
Don't know ............................

1
2
3
4
5

Q.39 Was there an alarm on the pool to alert when the water was disturbed?
(3512)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 147]

Q.40 Was the alarm on the pool working and activated at the time of the accident?
(3513)

Working and activated ..........
Working but not activated .....
Activated but not working ......
Neither working or activated .
Don't know ............................

1
2
3
4
5

[IF THE ANSWER TO QUESTION 33 IS 1, THEN SKIP TO QUESTION 147]

[IF THE ANSWER TO QUESTION 24 IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 43]

-10-

(3411-3510)

Q.41 How old is the pool, in years?
____________________

(3514-3523)

Q.42 How long have you lived in this home with the pool in the yard, in years please?
......... ________ (3524-3527)

Q.43 What was

(Victim's Name)

doing before the accident?
(3528)

Activity in the house ...
Activity in the yard ......
Activity near the pool ..
Playing in the pool ......

1
2
3
4

[IF THE ANSWER IS 2, THEN SKIP TO QUESTION 48]
[IF THE ANSWER IS 3, THEN SKIP TO QUESTION 53]
[IF THE ANSWER IS 4, THEN SKIP TO QUESTION 147]

Q.44 How did the child gain access to the yard?
(3529)

Open door ........
Closed door ......
Open window ....
Closed window .
Don't know ........

1
2
3
4
5

[IF THE ANSWER IS 1 OR 3 OR 5, THEN SKIP TO QUESTION 48]

Q.45 Was there an alarm on the door or window to alert the homeowner that the door/window had been
opened?
(3530)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 48]

-11-

Q.46 Please describe the alarm on the door or window.
_______________________________________________________________________________

(3531-3630)

_______________________________________________________________________________

Q.47 Was the alarm on the door/window activated and working at the time of the accident?
(3631)

Working and activated ..........
Working but not activated .....
Activated but not working ......
Neither working or activated .
Don't know ............................

1
2
3
4
5

Q.48 This next question is about the type of barrier around the pool and where the child was with respect
to the barrier. Please listen to all the options before replying.
(3632)

Was the child outside of the fence for the pool but still in the yard? ...........................
Was the child already within the fence for the pool once through the door/window? ..
There was no fence for the pool or the yard ...............................................................
Don't know ..................................................................................................................
[IF THE ANSWER IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 53]

Q.49 Approximately how tall was the fence around just the pool, in feet?
......... ________ (3633-3636)

Q.50 Was the gate to the fence open or closed?
(3637)

Open gate .... 1
Closed gate .. 2
Don't know ... 3
[IF THE ANSWER IS 1 OR 3, THEN SKIP TO QUESTION 53]

-12-

1
2
3
4

Q.51 Was the closed gate locked or unlocked?
(3638)

Locked ....... 1
Unlocked .... 2
Don't know . 3

Q.52 Was the gate a self-latching gate or a self-closing gate?
(3639)

Yes ............. 1
No .............. 2
Don't know . 3

Q.53 Did the pool have an alarm on it to alert when the water was disturbed?
(3640)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 1 OR 2 OR 3, THEN SKIP TO QUESTION 147]

Q.54 What was

(Victim's Name)

doing just before the accident?
(3641)

Activity in the house ............................
Activity in the yard ..............................
Playing on the decking near the pool ..
Playing in the pool ..............................

1
2
3
4

[IF THE ANSWER IS 2, THEN SKIP TO QUESTION 59]
[IF THE ANSWER IS 3, THEN SKIP TO QUESTION 67]
[IF THE ANSWER IS 4, THEN SKIP TO QUESTION 70]

Q.55 How did the child get outside to the yard?
(3642)

Open door ........
Closed door ......
Open window ....
Closed window .
Don't know ........

1
2
3
4
5

[IF THE ANSWER IS 1 OR 3 OR 5, THEN SKIP TO QUESTION 59]

-13-

Q.56 Was there an alarm on the door or window to alert the homeowner that the door or window had
been opened?
(3643)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 59]

Q.57 Please describe the alarm on the door/window.
_______________________________________________________________________________

(3644-3743)

_______________________________________________________________________________

Q.58 Was the alarm or the door/window activated and working at the time of the accident?
(3744)

Working and activated ..........
Working but not activated .....
Activated by not working .......
Neither working or activated .
Don't know ............................

1
2
3
4
5

Q.59 Did the swimming pool have any type of fencing or enclosure around it?
(3745)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 62]

Q.60 Please describe the type of enclosure or fencing around the pool.
_______________________________________________________________________________
_______________________________________________________________________________

-14-

(3746-3845)

Q.61 Approximately how tall was the fence or enclosure, in feet?
......... ________ (3846-3849)

Q.62 What is the normal mode of entry to the swimming pool?
(3850)

Ladder ........
Steps ..........
Deck ...........
Other ..........
Don't know .

1
2
3
4
5

[IF THE ANSWER IS 1 OR 2 OR 3, THEN SKIP TO QUESTION 64]
[IF THE ANSWER IS 5, THEN SKIP TO QUESTION 67]

Q.63 Please describe the type of entry to the pool.
_______________________________________________________________________________

(3851-3950)

_______________________________________________________________________________

Q.64 Could this entryway be removed when the pool was not in use?
(3951)

Yes ............. 1
No .............. 2
Don't know . 3

Q.65 Was there any way to block the entrance to the pool so that the child could not access it?
(3952)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 67]

-15-

Q.66 Please describe how the entrance could be blocked.
_______________________________________________________________________________

(3953-4052)

_______________________________________________________________________________

Q.67 Was there any type of alarm on the pool to notify when a child had fallen or jumped into the pool?
(4053)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 70]

Q.68 Please describe the alarm on the pool.
_______________________________________________________________________________

(4054-4153)

_______________________________________________________________________________

Q.69 Was the alarm on the pool activated and working at the time of the accident?
(4154)

Working and activated ..........
Working but not activated .....
Activated but not working ......
Neither working or activated .
Don't know ............................

1
2
3
4
5

Q.70 Was the child using any type of swimming product, for instance water wings, noodles, inner tubes?
(4155)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 72]

-16-

Q.71 Please describe the type of swimming product that the child was using at the time of the accident.
_______________________________________________________________________________

(4156-4255)

_______________________________________________________________________________

Q.72 Were you able to see the bottom of the pool on the day of the accident?
(4256)

Yes ............. 1
No .............. 2
Don't know . 3

Q.73 Prior to the accident, had the child ever had any type of formal water instruction? This could include
water familiarity classes, beginner swimming lessons, deep water instruction, or water safety.
(4257)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 147]

Q.74 Please describe the type of water instruction the child had received including where the classes
were taken, the nature of skills taught and the approximate number of classes taken.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

[IF THE ANSWER TO QUESTION 73 IS 1, THEN SKIP TO QUESTION 147]

(4258-4757)

-17-

Q.75 Was the wading pool intentionally filled with water by a caregiver?
(4758)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 1 OR 3, THEN SKIP TO QUESTION 78]

Q.76 How did water get into the wading pool?
(4759)

Rainfall ................................
Child filled the wading pool .
Other ...................................
Don't know ..........................

1
2
3
4

[IF THE ANSWER IS 1 OR 2 OR 4, THEN SKIP TO QUESTION 78]

Q.77 Please describe how the wading pool became full of water.
_______________________________________________________________________________

(4760-4859)

_______________________________________________________________________________

Q.78 How long had the water been in the wading pool?
_______________________________________________________________________________
_______________________________________________________________________________

Q.79 What was the child doing before the accident?
(4960)

Activity inside the home ..... 1
Activity outside the home ... 2
Playing in the wading pool . 3
[IF THE ANSWER IS 2, THEN SKIP TO QUESTION 85]
[IF THE ANSWER IS 3, THEN SKIP TO QUESTION 88]

-18-

(4860-4959)

Q.80 How did the child gain access to the yard?
(4961)

Open door ........
Closed door ......
Open window ....
Closed window .
Don't know ........

1
2
3
4
5

[IF THE ANSWER IS 1 OR 3 OR 5, THEN SKIP TO QUESTION 85]

Q.81 Was the door/window locked before the child exited the home?
(4962)

Yes ............. 1
No .............. 2
Don't know . 3

Q.82 Was there an alarm on the door or window to alert the homeowner that the door/window had been
opened?
(4963)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 85]

Q.83 Please describe the alarm on the door/window.
_______________________________________________________________________________

(4964-5063)

_______________________________________________________________________________

Q.84 Was the alarm on the door/window activated and working at the time of the accident?
(5064)

Working and activated ..........
Working but not activated .....
Activated but not working ......
Neither working or activated .
Don't know ............................

-19-

1
2
3
4
5

Q.85 Were there any barriers around the wading pool to prevent the child from entering the water?
(5065)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 88]

Q.86 Please describe the type of barrier in place.
_______________________________________________________________________________

(5066-5165)

_______________________________________________________________________________

Q.87 Please describe how the child overcame the barrier to get access to the wading pool.
_______________________________________________________________________________

(5166-5265)

_______________________________________________________________________________

Q.88 Prior to the accident, had the child ever had any type of formal water instruction? This could include
water familiarity classes, beginner swimming lessons, deep water instruction or water safety.
(5266)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 147]

-20-

Q.89 Please describe the type of water instruction the child received including where the classes were
taken, the nature of skills taught and the approximate number of classes taken.
_______________________________________________________________________________

(5267-5766)

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

[IF THE ANSWER TO QUESTION 88 IS 1, THEN SKIP TO QUESTION 147]

Q.90 Of the following shapes, please select the shape that describes the top of the bucket.
(5767)

Circle ..........
Square .......
Rectangle ...
Oval ............
Don't know .

1
2
3
4
5

Q.91 Can you recall the amount of liquid that the bucket can hold total?
We're looking for answers like 5 gallons, 4 quarts, etc.
_______________________________________________________________________________
_______________________________________________________________________________

-21-

(5768-5867)

Q.92 What was the bucket being used for at the time of the accident?
(5868)

Cleaning .........
Storage ..........
Laundry ..........
Water supply ..
Other ..............
Don't know .....

1
2
3
4
5
6

[IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 6, THEN SKIP TO QUESTION 94]

Q.93 Please describe what the bucket was being used for before the accident.
_______________________________________________________________________________

(5869-5968)

_______________________________________________________________________________

Q.94 Please describe the contents of the bucket at the time of the accident.
_______________________________________________________________________________

(5969-6068)

_______________________________________________________________________________

Q.95 What room was the bucket in?
No need to read the responses unless the respondent doesn't know or hesitates.
(6069)

Kitchen .......
Bathroom ....
Hallway .......
Bedroom .....
Utility room .
Garage .......
Outside .......
Other ..........
Don't know ..

1
2
3
4
5
6
7
8
9

[IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 9, THEN SKIP TO QUESTION 97]

-22-

Q.96 Please specify the Other room that the bucket was located in at the time of the accident.
_______________________________________________________________________________

(6070-6119)

Q.97 How long had the liquid been in the bucket prior to the accident?
_______________________________________________________________________________

(6120-6219)

_______________________________________________________________________________

Q.98 When

(Victim's Name)

fell into the bucket, did the bucket tip over or stay upright?
(6220)

Tipped over ......
Stayed upright ..
Neither .............
Don't know .......

1
2
3
4

[IF THE ANSWER IS 1 OR 2 OR 4, THEN SKIP TO QUESTION 147]

Q.99 Please describe what happened to the bucket when the child fell into the bucket.
_______________________________________________________________________________
_______________________________________________________________________________

[IF THE ANSWER TO QUESTION 98 IS 3, THEN SKIP TO QUESTION 147]

-23-

(6221-6320)

Q.100 Where was the spa/hot tub located?
(6321)

Own residence ....................................................
Other's residence ................................................
Recreational area/public area/hotel/motel/other .
Don't know ..........................................................

1
2
3
4

[IF THE ANSWER IS 1 OR 2, THEN SKIP TO QUESTION 102]

Q.101 Was there a lifeguard supervising the hot tub at the time of the accident?
(6322)

Yes ............. 1
No .............. 2
Don't know . 3

Q.102 This next question is a bit more specific about the location of the hot tub. Please choose which
best describes the specific location of the hot tub. Was the hot tub...
(6323)

Indoors ...........................
Outdoors ........................
In a covered porch area .
Other ..............................
Don't know ......................

1
2
3
4
5

[IF THE ANSWER IS 1 OR 2 OR 3 OR 5, THEN SKIP TO QUESTION 104]

Q.103 Please describe the Other location of the hot tub.
_______________________________________________________________________________
_______________________________________________________________________________

Q.104 Was the hot tub in-ground or above-ground?
(6424)

In-ground ........ 1
Above-ground . 2
Don't know ...... 3

-24-

(6324-6423)

Q.105 Was there any type of barrier around the hot tub, like a fence or a door to prevent access to the hot
tub?
(6425)

Fence .........
Door ...........
None ..........
Other ..........
Don't know .

1
2
3
4
5

[IF THE ANSWER IS 1 OR 2, THEN SKIP TO QUESTION 107]
[IF THE ANSWER IS 3 OR 5, THEN SKIP TO QUESTION 111]

Q.106 Please describe the Other type of barrier around the hot tub.
_______________________________________________________________________________

(6426-6525)

_______________________________________________________________________________

Q.107 Was the barrier open or closed before the child gained access to the hot tub?
(6526)

Open .......... 1
Closed ........ 2
Don't know . 3
[IF THE ANSWER IS 1 OR 3, THEN SKIP TO QUESTION 111]

Q.108 Was there any type of alarm or lock on the barrier to alert/stop entry into the hot tub?
(6527)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 111]

Q.109 Please describe the alarm or lock on the barrier to the hot tub.
_______________________________________________________________________________
_______________________________________________________________________________

-25-

(6528-6627)

Q.110 Was the alarm or lock on the barrier to the hot tub working at the time of the incident?
(6628)

Yes ............. 1
No .............. 2
Don't know . 3

Q.111 Did the child have permission to be in the area of the hot tub?
(6629)

Yes ............. 1
No .............. 2
Don't know . 3

Q.112 Was there a cover on the hot tub at the time of the accident?
(6630)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 1 OR 2 OR 3, THEN SKIP TO QUESTION 147]

Q.113 Did
(Victim's Name)
fall into the bathtub, climb into the bathtub, or was
placed in the bathtub by a caregiver?

(Victim's Name)

(6631)

Fell into the bathtub ........
Climbed into the bathtub .
Placed into the bathtub ...
Don't know ......................

1
2
3
4

[IF THE ANSWER IS 3, THEN SKIP TO QUESTION 119]

Q.114 Was there standing water in the bathtub at the time or did
with water?

(Victim's Name)

(6632)

Standing water in the tub .
Victim filled the tub ...........
Other ................................
Don't know .......................

1
2
3
4

[IF THE ANSWER IS 1, THEN SKIP TO QUESTION 116]
[IF THE ANSWER IS 2 OR 4, THEN SKIP TO QUESTION 117]

-26-

fill the bathtub

Q.115 Please describe how the water got into the bathtub.
_______________________________________________________________________________

(6633-6732)

_______________________________________________________________________________

Q.116 How long before the accident had the water been in the bathtub?
_______________________________________________________________________________

(6733-6832)

_______________________________________________________________________________

Q.117 Were other children involved in the accident?
(6833)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 147]

Q.118 Please describe how the other children were involved in the accident.
Interviewer: Probe for ages of other children.
_______________________________________________________________________________

(6834-6933)

_______________________________________________________________________________

[IF THE ANSWER TO QUESTION 117 IS 1, THEN SKIP TO QUESTION 147]

Q.119 Approximately how deep was the water at the time of the accident, in inches please?
......... ________ (6934-6937)

-27-

Q.120 Was the water left running at the time of the accident?
(6938)

Yes ............. 1
No .............. 2
Don't know . 3

Q.121 Was the drain open or closed at the time of the accident?
(6939)

Open .......... 1
Closed ........ 2
Don't know . 3
[IF THE ANSWER IS 2, THEN SKIP TO QUESTION 124]
[IF THE ANSWER IS 3, THEN SKIP TO QUESTION 125]

Q.122 Had anything blocked the drain or was the water draining as intended?
(6940)

Blocked drain ............. 1
Draining as intended .. 2
Don't know ................. 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 125]

Q.123 What was blocking the drain?
_______________________________________________________________________________

(6941-6990)

[IF THE ANSWER TO QUESTION 122 IS 1, THEN SKIP TO QUESTION 125]

Q.124 What was used to plug the drain?
_______________________________________________________________________________

-28-

(6991-7040)

Q.125 Was the child using any type of bathing aid at the time of the accident?
(7041)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 128]

Q.126 Was the product a:
(7042)

Bathinette .............
Bath seat ..............
Baby bath tub .......
Inflatable support ..
Other ....................

1
2
3
4
5

[IF THE ANSWER IS 1 OR 2 OR 3 OR 4, THEN SKIP TO QUESTION 128]

Q.127 What was the Other product that the child was using at the time of the accident?
_______________________________________________________________________________

(7043-7142)

_______________________________________________________________________________

Q.128 Were any other children involved in the accident?
(7143)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 130]

Q.129 Please describe how the other children were involved in the accident.
Interviewer: Probe for ages of other children.
_______________________________________________________________________________
_______________________________________________________________________________

-29-

(7144-7243)

Q.130 Prior to the accident, had the door of the bathroom been open or closed?
(7244)

Open ..................................
Closed ................................
Don't know .........................
Did not occur in bathroom ..

1
2
3
4

[IF THE ANSWER TO QUESTION 128 IS 1 OR 2 OR 3, THEN SKIP TO QUESTION 147]

Q.131 Usually, is the toilet lid left open or closed?
(7245)

Open .......... 1
Closed ........ 2
Don't know . 3

Q.132 On this particular occasion, was the toilet lid left open or closed?
(7246)

Open .......... 1
Closed ........ 2
Don't know . 3

Q.133 Was there a toilet lock on the toilet?
(7247)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 147]

Q.134 Was the toilet locked in place at the time of the accident?
(7248)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 147]

-30-

Q.135 Had the child previously defeated the toilet lock?
(7249)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 1 OR 2 OR 3, THEN SKIP TO QUESTION 147]

Q.136 Was the pond a man-made pond with a liner?
(7250)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 1, THEN SKIP TO QUESTION 139]

Q.137 Was this a natural pond?
(7251)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 1, THEN SKIP TO QUESTION 139]

Q.138 Please describe the type of pond involved in the accident.
_______________________________________________________________________________
_______________________________________________________________________________

Q.139 Before the accident occurred, was the child taking part in:
(7352)

An activity inside the house ........ 1
An activity outside of the house .. 2
Don't know ................................. 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 144]

-31-

(7252-7351)

Q.140 How did the child gain access to the area near the pond?
(7353)

Open door ........
Closed door ......
Open window ....
Closed window .
Don't know ........
Other ................

1
2
3
4
5
6

[IF THE ANSWER IS 1 OR 3 OR 5 OR 6, THEN SKIP TO QUESTION 144]

Q.141 Was there an alarm or lock on the door or window to alert the homeowner that the door/window
had been opened?
(7354)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 144]

Q.142 Please describe the alarm or lock on the door/window.
_______________________________________________________________________________
_______________________________________________________________________________

Q.143 Was the alarm or lock on the door/window working at the time of the incident?
(7455)

Yes ............. 1
No .............. 2
Don't know . 3

Q.144 Was there any type of barrier around the pond to prevent access to the pond?
(7456)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 147]

-32-

(7355-7454)

Q.145 Please describe the type of barrier around the pond.
_______________________________________________________________________________

(7457-7556)

_______________________________________________________________________________

Q.146 How did the child get past the barrier?
_______________________________________________________________________________

(7557-7656)

_______________________________________________________________________________

Q.147 I'm now going to ask some information about
What was

(Victim's Name)

(Victim's Name)

.

's age at the time of the accident?
(7657)

1 month to 23 months old ......
2 years old to 35 months old ..
3 years old to 47 months old ..
4 years old or older ................

1
2
3
4

Q.148 The following race and ethnicity questions will help us better focus our outreach and education
efforts related to consumer product safety.
Are you/your child Hispanic or Latino?
(7658)

Yes .............
No ..............
Don't know .
Refused ......

-33-

1
2
3
4

Q.149 Please read race choices aloud and ask the responden to select ALL catgories that apply. If the
respondent replies with anything other than the first 5 categories, select "Other" and on the next
question, enter the answer verbatim.
(7659-7664)

White ................................................
Black or African American ................
American Indian or Alaska Native ....
Native Hawaiian or Pacific Islander ..
Asian ................................................
Other ................................................
Don't know .......................................
Refused ............................................

1
2
3
4
5
6
7
8

[IF THE ANSWER IS NOT 6, THEN SKIP TO QUESTION 151]

Q.150 Please specify "other" race.
If the respondent states "biracial" or "multiracial", please prompt for specifics (country of origin,
nationality, etc.). Otherwise, simply state "biracial" or "multiracial"
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

[IF THE ANSWER TO QUESTION 147 IS 2 OR 3 OR 4, THEN SKIP TO QUESTION 157]

-34-

(7665-7920)

Q.151 I'm going to list some developmental milestones for children under 2 years old. Please answer yes
or no as to whether
(Victim's Name)
was able to do this task at the time of the accident.
Roll over?
(7921)

Yes ............. 1
No .............. 2
Don't know . 3

Q.152 Sit up?
(7922)

Yes ............. 1
No .............. 2
Don't know . 3

Q.153 Pull up to a stand?
(7923)

Yes ............. 1
No .............. 2
Don't know . 3

Q.154 Stand alone?
(7924)

Yes ............. 1
No .............. 2
Don't know . 3

Q.155 Crawl?
(7925)

Yes ............. 1
No .............. 2
Don't know . 3

Q.156 Walk?
(7926)

Yes ............. 1
No .............. 2
Don't know . 3

-35-

Q.157 Can you please tell me
measurement

(Victim's Name)

's height at the time of the accident? Specify units of

_______________________________________________________________________________

(7927-8026)

_______________________________________________________________________________

Q.158 Can you please tell me (Victim's Name) 's weight at the time of the accident? Specify the units of
measurement
_______________________________________________________________________________

(8027-8076)

Q.159 Did the victim have any physical or mental disabilities that may have contributed to the accident?
(8077)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 161]

Q.160 Please describe the disability that may have contributed to the accident.
_______________________________________________________________________________

(8078-8177)

_______________________________________________________________________________

Q.161 At the time of the accident, was
(Victim's Name)
without help from someone else or a flotation aid?
(8178)

Yes ............. 1
No .............. 2
Don't know . 3

-36-

able to keep his/her head above water

Q.162 What was
(Victim's Name)
wearing at the time of the accident (waterwings, flotation
devices, swimsuit, clothes, etc.)?
_______________________________________________________________________________

(8179-8278)

_______________________________________________________________________________

Q.163 I just have a few more questions. I'd like to ask about what happened after the child became
submerged in the water. Did a caregiver bring
(Victim's Name)
to the emergency room or
was an ambulance called to transport
(Victim's Name) ?
(8279)

Brought by caregiver to ER ....
Brought by ambulance to ER .
Other ......................................
Don't know ..............................

1
2
3
4

[IF THE ANSWER IS 1 OR 2 OR 4, THEN SKIP TO QUESTION 165]

Q.164 Please specify the other way (Victim's Name) was brought to the emergency room.
_______________________________________________________________________________

(8280-8379)

_______________________________________________________________________________

Q.165 Was CPR attempted following the accident?
(8380)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 2 OR 3, THEN SKIP TO QUESTION 167]

Q.166 Who performed CPR on

(Victim's Name) ?

_______________________________________________________________________________

-37-

(8381-8430)

Q.167 Do you recall how much time passed from when the child was found and when the child received
professional medical attention? Specify units of measurement
_______________________________________________________________________________

(8431-8530)

_______________________________________________________________________________

Q.168 Who was the professional medical person that gave attention?
_______________________________________________________________________________

(8531-8630)

_______________________________________________________________________________

Q.169 Is (Victim's Name) still under medical care due to the accident?
(8631)

Yes ............. 1
No .............. 2
Don't know . 3
[IF THE ANSWER IS 1 OR 3, THEN SKIP TO QUESTION 171]

Q.170 How long was

(Victim's Name)

under medical care after the accident?

_______________________________________________________________________________

Q.171 What is the long term medical outlook for

(Victim's Name)

?

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

-38-

(8632-8681)

(8682-8881)

Q.172 Who was supervising

(Victim's Name)

at the time of the accident?
(8882)

Family member .
Friend ...............
Baby sitter .........
Other .................

1
2
3
4

[IF THE ANSWER IS 3, THEN SKIP TO QUESTION 174]

Q.173 Please describe the relationship of the caregiver and

(Victim's Name)

.

_______________________________________________________________________________

(8883-8982)

_______________________________________________________________________________

Q.174 Can you tell me the approximate age of the caregiver?
......... ________ (8983-8986)

Q.175 READ WITH GREAT SENSITIVITY!!!
The way caregivers supervise children varies by the situation and the activity of the child as well as
the child's age. I have some different forms of supervision that I will read to you. Please indicate the
type of supervision of
(Victim's Name)
at the time of the accident. Was the caregiver:
(8987)

Within arm's reach of the child .........................................................
Directly watching the child, but not necessarily within arm's reach ..
Periodically looking in on the child ...................................................
Able to hear the child's actions .........................................................
Other/Refused ..................................................................................
Don't know .......................................................................................

1
2
3
4
5
6

[IF THE ANSWER IS 1 OR 2 OR 3 OR 4 OR 6, THEN SKIP TO QUESTION 177]

-39-

Q.176 Please describe the Other type of supervision the child had at the time of the accident.
_______________________________________________________________________________

(8988-9187)

_______________________________________________________________________________
_______________________________________________________________________________

Q.177 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?
(9188)

Yes . 1
No ... 2

Q.178 Thank you for your time.
End Interview

Q.179 Interviewer: What is the date this interview was completed (MM/DD/YY)?
____________________

-40-

(9189-9198)