BUNN01 fire - outdoor gasoline appliances with SAMPLE

BUNN01 fire - outdoor gasoline appliances with SAMPLE.pdf

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

BUNN01 fire - outdoor gasoline appliances with SAMPLE

OMB: 3041-0029

Document [pdf]
Download: pdf | pdf
INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Fire – Ground Supported Outdoor Gasoline Powered Appliances with SAMPLE COLLECTION
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID: BUNN01 2020

FOLLOW-UP REQUESTED:

HAZARD ANALYSIS

COMPLIANCE

PRIMARY CONTACT: Han Lim, ESMC, 301-987-2327, [email protected]
BACK-UP CONTACT: David Miller, EPHA, 301-504-7323, [email protected]
ASSIGNMENT MESSAGE:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

Identify the product – snow blower, pressure washer, rototiller, etc.
Identify the victim(s) – operator, passenger, or bystander.
Obtain the brand name (manufacturer), model name/number, and horsepower of the appliance.
How old is the appliance?
Provide a chronology of events leading to the fire incident, or fire hazard.
Were there any gas-fired appliances such as gas water heaters or gas clothes dryers near the appliance?
Were there any observations of fuel leaks prior to the fire from any of the fuel system components, e.g.,
carburetor, cracks/holes/split seams in the fuel tank, fuel hoses, fuel filter, vent grommets, etc.?
What type of surface was the appliance placed on during the fire, e.g., concrete floor, asphalt, dirt
floor, grassy field, laminate floor, etc.?
At the time of the incident, was the engine running or not running?
Describe whether there were any environmental conditions such as wet grass, uneven surfaces (holes,
bumps, rocks, or obstacles), a steep embankment or anything else that may have contributed to the incident.
Was the appliance on level ground or was it on a hill or slope just before the incident?
Were there any combustible materials near the appliance, such as leaves, paper, etc? If yes, list them.
Was the appliance involved in a CPSC recall?
What is the maintenance history of the appliance, on items such as oil changes?
Was the appliance manufacturer contacted about this fire incident or for any other product related matter?
Are there are markings on the appliance indicating certification to any industry standards such as ANSI,
ASTM, UL, etc.?

Along with answering the questions from the assignment message, please collect the gasoline
powered equipment sample if possible. If shipping the entire unit is not feasible, carefully
disassemble and ship the empty fuel tank and hoses, as it was the alleged source of fuel leak.
Ship the samples to CPSC Rockville, 5 Research Place, Rockville, MD 20850, attn: Han Lim.
Please include all primary and all backup contacts in the distribution of the completed IDI.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Area below will be completed in Data Systems _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Person(s) to Contact:
Guidelines:
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew


File Typeapplication/pdf
AuthorPreferred Customer
File Modified2019-09-06
File Created2019-09-06

© 2024 OMB.report | Privacy Policy