TYNN05 childrens products - general

TYNN05 childrens products - general.pdf

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

TYNN05 childrens products - general

OMB: 3041-0029

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INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Children’s Products, General
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID: TYNN05 2020

FOLLOW-UP REQUESTED

HAZARD ANALYSIS

SECT 15

PRIMARY CONTACT: Hope Nesteruk, ESME, 301-987-2579, [email protected]
BACK-UP CONTACT: Celestine Kish, ESHF, 301-987-2547, [email protected]
ASSIGNMENT MESSAGE:

Deaths and serious injuries to children, which may be associated with a variety of products, may be
assigned throughout the year, depending upon Commission requirements. For serious incidents not
specifically addressed in the Criteria & Rationales, assignments should be made after consultation
with Headquarters’ staff.
Determine product description, brand name, model; photograph product if possible. Determine age
of product, manufacturer, and place of purchase.
Determine sequence/scenario of events, treatment administered and patient disposition. If more
than one person involved, explain how others were involved. Collect all official documentation
(paramedics, police, and coroner reports, medical records, death certificate).
Determine if product failure or faulty product design was a factor.
If entrapment played a role in the incident, obtain dimensions of the area of entrapment. Re-enact
the entrapment using a doll or stuffed animal.
If there are broken parts, collect the parts and/or the product as a sample.
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: Check the Alph_listing_guidelines document in IFS for relevant guidelines.
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew


File Typeapplication/pdf
File TitleACCIDENT INVESTIGATION REQUEST FORM
AuthorPreferred Customer
File Modified2019-09-13
File Created2019-09-13

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