STNN34 carbon monoxide fatality - DEATH CERTS

INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Carbon Monoxide Fatality from Death Certificates
DOCUMENT NUMBER:
DATE OF INCIDENT:
FOLLOW-UP REQUESTED

CATID: STNN34 2020
HAZARD ANALYSIS

SECT 15

PRIMARY CONTACT: Matthew Hnatov, EPHA, 301-504-7403, [email protected]
BACK-UP CONTACT: Susan Bathalon, ESFS, 301-987-2282, [email protected]
Only if a generator is involved, also include:
COMPLIANCE CONTACTS: Blake Rose, CDI, 301-504-7613, [email protected]
ASSIGNMENT MESSAGE:

Please conduct an investigation of the attached carbon monoxide fatality. The FUEL-BURNING
PRODUCT, FUEL TYPE, LOCATION, APPLIANCE AGE, and TOTAL NUMBER OF VICTIMS
involved in this incident are crucial information that will be used to generate the annual statistical
estimates of NON-FIRE CO deaths and injuries. These annual estimates are published every year by
Hazard Analysis and are released to the public.
Use Appendix 16 (revised 2005) – All Carbon Monoxide Poisoning-Related Incidents for reference.
However, since CPSC generally receives death certificates 6-18 months after the death occurred, we
recognize that some information may not be available to you. Please complete as much of the data
recording sheets as you are able to with the information available.
If CO is determined to be due to automobile exhaust or an intentional act, then complete a screening
report as instructed in the Field Manual for Investigation Procedures and Reporting Techniques (VIII.B,
p.63).
If the CO poisoning is determined to be due to a fire incident AND there is no special study currently
associated with the product hazard (refer to Criteria and Rationales manual), then complete an
abbreviated report as instructed in the Field Manual for Investigation Procedures and Reporting
Techniques (VIII.C, p.58).
Otherwise, please attempt to obtain as much of the following as possible through official documents and
interviews:
1. Incident scenario
2. Identify / confirm the fuel-burning product(s) that generated the CO as precisely as possible: for
example, furnace (central heating), boiler (central heating that uses radiators), vented space heater, unvented space heater, portable camping heater, generator, etc.
a) Please differentiate between vented and un-vented gas space heaters.
b) Please identify if the heater is portable or hard plumbed into the house piping or venting systems.
c) Please provide the appliance manufacturer, age or installation date, and model numbers. These
are very important pieces of information.

CPSC FORM 324A

d) Please be sure to differentiate between boilers, wall furnaces, forced air furnaces, floor furnaces.
These are all different products covered by different voluntary standards, and we need to know
which appliances are involved so we can make recommendations to the appropriate standards.
e) When was the most recent service performed on the appliance and what was done?
3. Type of fuel used by product(s) that generated the CO: for example, natural gas, LP gas (includes
propane, butane, and white gas), kerosene, oil, gasoline, coal, wood, etc.
4. Location of incident
5. Carboxyhemoglobin (COHb) level in victim(s) as determined by lab tests or autopsy (usually expressed
as a percentage)
6. All CO measurements taken by fire dept. or utilities.
7. If a CO alarm or combined CO/smoke alarm is present, obtain location of alarm.
a) Obtain manufacturer name, model number, copy of instruction, photo of front and back of
alarm.
b) Obtain information about previous experience with the alarm:
1) Has it alarmed before?
2) Has it gone into trouble signal in the past?
3) When was it installed?
4) If it is a battery operated unit, when were the batteries changed last?
5) Does the consumer routinely use spray deodorizers, air fresheners, or ammoniacontaining cleaners near the alarm?
If next-of-kin or eyewitness interviews are permitted, please try to obtain the following information as
well:
• Product description, including the age of the product
• Number of ALL victims involved in the incident, their gender and age. For non-fatally injured
victims, describe symptoms and treatment received. Obtain any COHb measurements taken from
blood tests.
• Whether CO alarms were present and if/how they operated prior to and during the incident.
OBTAIN COPY OF AUTOPSY REPORT, FIRE REPORT, EMERGENCY RESPONSE REPORT,
UTILITY REPORT, REPAIR ORDER, MEDICAL EXAMINER’S OR ANY OTHER OFFICIAL
REPORT.
Complete the relevant portion(s) of Appendix 16 required for this IDI as fully as possible. Due to
the lag in state reporting of death certificates and contract restrictions placed on investigations
initiated from death certificates, we recognize that some information may be difficult to obtain to
complete the required portion(s) of the Appendix 16 Data Record Sheets. However, we request
that the investigator provide as much information as possible in the Data Record Sheets.
Additional requirements for this IDI ONLY IF A GENERATOR IS INVOLVED:
Request for additional information for IDI’s assigned for deaths related to portable generators.
The Office of Compliance and Field Operations would like to review the CO poisoning hazard
labels on the generators involved with fatalities for compliance with the labeling requirements of
16 C.F.R. § 1407. Compliance will follow-up with the manufacturers of any products found to be
non-compliant.

CPSC FORM 324A

Copies of the mandated on-product and on-package CO poisoning hazard labels are shown below.
If you suspect that the labeling on a generator does not meet the requirements, please photograph
the top and each side of the generator. Inquire if the consumer has retained the outer packaging of
the generator, if so, evaluate the hazard labels on the packaging for compliance.
Requirements for placement of the labels:
On-product hazard labels:
The on-product hazard label must be permanently affixed and located:
A) On a part of the portable generator that cannot be removed without the use of tools, and
B) On a location that is prominent and conspicuous to an operator while performing at least
two of the following actions: Filling the fuel tank, accessing the receptacle panel, and
starting the engine.
On-package hazard labels:
The on-package hazard label must be located on the principal display panel(s) of the package AND
the surface containing the top flaps of the package. The principal display panel(s) of the package is
the portion(s) of the outer packaging that is designed to be most prominently displayed, shown,
presented, or examined under conditions of retail sale.

Generator On-Product Label

Generator On-Package Label

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: Appendix 16 – All Carbon Monoxide Poisoning-Related Incidents,
including relevant portion(s) of Data Recording Sheet
Task Number:
Assigned to:

CPSC FORM 324A

Date:
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