ELNN01 electrical hazards - electrocution & shock

INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Electrical Hazards – Electrocution/Electric Shock
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID: ELNN01 2020

FOLLOW-UP REQUESTED

HAZARD ANALYSIS

COMPLIANCE

PRIMARY CONTACT: Doug Lee, EXHR, 301-987-2073, [email protected]
BACK-UP CONTACTS: Andrew Trotta, ESEFE, 301-987-2057, [email protected]
ASSIGNMENT MESSAGE:

Please conduct an investigation on this case where an electrocution or electric shock occurred.
Describe the scenario surrounding the incident. Obtain pre-incident, incident, and post-incident
information. Identify all products by manufacturer and model numbers. If possible, collect
owners/users manual for all appliances involved.
For internet connected incident products (IoT) 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. Use Appendix 140 for IoT incidents.

OBTAIN COPY OF FIRE REPORT, MEDICAL EXAMINER’S OR ANY OTHER
OFFICIAL REPORT.
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: Electrocutions – Appendix 34, Appendix 128
For Internet of Things: IoT/Connected Products – Appendix 140
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew