SECTTV - Compliance Tipover GENERAL incident

INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Compliance Tip-Over Program Incident – SECTTV 2020
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID:

FOLLOW-UP REQUESTED

HAZARD ANALYSIS

SECT 15

PRIMARY CONTACT:
BACK-UP CONTACT: Gina Collins, 301-504-7595, [email protected]
ASSIGNMENT MESSAGE:
Please investigate the attached

fatal

non-fatal incident involving a

[general name of product]

This assignment is to be completed as
on-site investigation
telephone investigation
on-site investigation if sample available, otherwise telephone investigation
Priority level:

AA

BB

CC

Justification for AA or BB priority:
STATE in which incident occurred:
Incident and/or exemplar sample collection for Commission evaluation:
Yes, obtain entire product, if available
Yes, obtain part of product []
Obtain [] exemplar(s).
No sample collection necessary

Note: only one sample collection box above can by marked in the system – please see Instructions to Investigator section below for additional sample collection information, if applicable.

Instructions to Investigator:

It is important to collect as much information as possible about the product(s) and the incident scenario.
Document incident scenario and, if possible, photograph product(s) involved in the tipover/entrapment. Also, please
obtain the following information:
1.

Document all manufacturer/brand and serial/model information, including production dates, if available. For
furniture, markings may be inside the drawer or found on a label on the back of the furniture. For televisions,
note whether it is a box or flat screen television, and indicate the size of the television (giving precise
measurements if available).

2.

How old is the product(s)? When was the product(s) purchased? Was it purchased new or used? From whom
was the products(s) purchased? What type of store was the product(s) purchased from (product specific store
such as electronics, furniture, or appliance store, or a big box store, a department store, a rent to own store,
etc.)?

3.

Did the product have anti-tipping or stability feature, was it installed, by whom (consumer or professional) and
date of purchase. What type of anti-tipping feature did the consumer use and describe how it was installed. If
obtained second hand, determine if warnings or use instructions accompanied the product(s). Was the product
modified by the consumer? If the anti-tipping or stability feature is available, please photograph the
component as it was used during the incident, and please collect it as a sample.

CPSC FORM 324A

4.

Was the incident witnessed? Describe the victim’s activity that brought about the incident, was victim trying to
retrieve an object from inside or on top of the product? Were there any objects in the area that may have
motivated the victim to interact with the product?

5.

Describe in detail the event that resulted in tip-over or collapse. In your opinion, was there over loading of
objects that may have caused instability or shift in center of gravity. Were there previous complaints with the
product(s) particularly related to tip-over or stability?

6.

Describe the type of surface (hard floor carpet etc.) that the product(s) on? Was it a leveled surface? At the
time of the incident was the product placed on or have rollers? Measure the distance from the front of the
furniture to where the rollers pivot about the vertical axis. Measure the diameter of the rollers. Was the
surface wet or have other factors that may have contributed to the incident.

7.

If the furniture has rollers, turn the rollers so that they are pointing inside (away from the tip direction). A.)
Measure the diameter of the rollers. B.) Measure the horizontal distance from center of the roller to the front
of the furniture.

Figure 1 - Rollers pointed outward

Figure 2 - Rollers pointed inward

Front of the
furniture

Center of
the Roller

Center of the
Roller

Diameter

Figure 3 – Locations on the roller
8.

Figure 4 – Furniture Tip Distance

If the furniture has feet (not rollers), measure the shortest distance from the front of the foot to the front of the
furniture.

CPSC FORM 324A

9.

If an appliance was involved, determine where the appliance was located prior to the incident. Please
approximate the distance between the front of the appliance and the front of the furniture.

10. Document any object placed in or on product(s), the object’s location (i.e. on top, inside, etc), and the object’s
approximate weight. Identify any limitations as to size or weight of objects that could be placed in or on
product. Document the product being place in or on any other object such as tables, dressers, stands, carts, etc.
11. Be mindful of the product and ask as many product specific questions as possible. Please feel free to add
questions that you feel are appropriate to ask even if they are not listed here.
12. What was the extent of injuries from the incident? How did the product trap the victim i.e. what part of the
body became entrapped? Describe in detail the position of the body with relation to the object, use illustration
when possible.
13. Identify and photograph all labels regarding certification, testing or conformance with mandatory or voluntary
standards related to tip-over, collapse or entrapment. The text of any warning or age labeling on or
accompanying the product particularly
14. Collect as much information as possible about the product or products involved (weight, height, width, depth,
number of drawers, number of shelves and doors, type of feet, type of material, type of contents (clothes,
books, etc.), information that would help in the analysis as to cause/reason for tip over and seriousness of
injury.
15. Include the victim’s age, sex, height, and weight.
16. Specify the location (e.g., home, daycare, etc.) where the incident occurred and the room where the incident
occurred (kitchen, living room, bedroom, etc.).
17. Felt anti-scruff pads and metal foot tacks can change how furniture tips. Please photograph the bottom of the
furniture, including an overall photo with a close-up of the feet or casters nearest where the furniture tipped.
Obtain all official reports.
Verify incident scenario. Provide complete product identification including: manufacturer, brand, date
manufactured, place of purchase, date of purchase, model/serial numbers, cost, etc.

Include Gina Collins in the distribution of the completed IDI.
If the incident involves a fatality, also include Adam Suchy (EPHA) in the
distribution of the completed IDI.
Please include all primary and all backup contacts in the distribution of the completed IDI.
If this assignment is requested by Compliance but is listed as a category in the Criteria and Rationales, then the report should also
meet the requirements of the Criteria and Rationales including use of any applicable guidelines and data record sheets. For
assignments requested by EP, if it is clear that a product defect is involved, then the report must also meet Compliance requirements.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Area below will be completed in Data Systems _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Person(s) to Contact:
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew