BUNN01 a GENERAL fire thermal burns - YES SAMPLE

INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Fires and Thermal Burns, General – YES SAMPLE
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID: BUNN01 2020

FOLLOW-UP REQUESTED:

HAZARD ANALYSIS

COMPLIANCE

PRIMARY CONTACT: David Miller, EPHA, 301-504-7323, [email protected]
BACK-UP CONTACT: Rik Khanna, EXHR, 301-987-2508, [email protected]
Cheryl Scorpio, HS, 301-987-2572, [email protected]
Scott Ayers, ESEF, 301-987-2030, [email protected]
Yeon Kim, ESEF, 301-987-2258, [email protected]
ASSIGNMENT MESSAGE:
Obtain a detailed scenario of the incident. Describe injured persons and extent of injury (fatal or non-fatal) and
treatment. Describe factors relevant to explain how and why the person was injured. Include discussion of any
malfunctions, deficiencies, or use features of the product that contributed to the occurrence of injuries.
Obtain fire incident report and any other reports regarding the cause of the incident.
Provide complete product identification, including age of product, manufacturer, brand, date manufactured,
place and date of purchase, model/serial numbers, etc.
Internet of Things (IoT): Additionally, the CPSC and outside stakeholders are focused on the Internet of Things
(IoT) and its safety and security. CPSC have been collecting incident data involving electrical appliances and other
electrical equipment that are remotely controlled over the internet to assess safety hazards caused by being remotely
connected to the internet (within CPSC’s jurisdiction). For internet connected incident products where the internet
connection has led to the incident, describe how the remote connection to the internet caused the safety hazard and
collect information on the smartphone or other internet connected device and software versions used on the internet
connected device.
Please collect the incident sample during this investigation.
Please include all primary and all backup contacts in the distribution of the completed IDI.
For IoT cases, use App. 140 and include Doug Lee, EXHR, in the distribution of the completed IDI.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Area below will be completed in Data Systems _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Person(s) to Contact:
Guidelines: For Internet of Things: IoT/Connected Products – Appendix 140
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew