TLNN01 go-karts and fun-karts

INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Fun-Karts and Go-Karts
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID: TLNN01 2020

FOLLOW-UP REQUESTED

HAZARD ANALYSIS

SECT 15

PRIMARY CONTACT: John Topping, EPHA, 301-504-7329, [email protected]
BACK-UP CONTACT: Brian Baker, LSM, 301-987-2289, [email protected]
ASSIGNMENT MESSAGE:
Conduct an on-site investigation of the go-kart/fun-kart related incident discussed in the attached document. If the
product is homemade (made from several parts of discarded fun-karts/go-karts or lawn mowers), terminate the
investigation. Otherwise, if not homemade, obtain the following information, including pictures where applicable:
1. Accident scenario, including but not limited to the following information:
• Time, date, and weather conditions – estimated (e.g., fog, rain, high heat, snow) during the time of the
incident.
• Surface conditions during the time of the incident (e.g., mud, dirt, dust, loose soil, high grass, frozen,
asphalt/tarmac/concrete)
2. Location of the incident (private road, amusement park, off-road, or other)
3. Brand, model, age, and condition of the go-kart/fun-kart
4. The incident sample go-kart/fun-kart itself (if available for release)
Additionally, photograph all aspects of the machine including detailed photos of the parts involved with labels, the
model, make/manufacturer, VIN (if provided), any warning labels, and the surrounding area where the product was
used. Obtain a copy of the owner's manual, as well as the height and weight of any operators involved, if available.
In case of fatality, obtain copies of medical or official reports.

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 117
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew