This form is for use by state Attorney General and Health Department offices, or fire, police, and insurance investigators to report injuries or deaths involving consumer products, or unsafe products, to CPSC. We may contact you by mail, phone or Internet email for further details. In addition, you will be contacted to confirm the information you sent. Please provide as much information as possible. Your name, address, and telephone number are optional, but we can't contact you without that information. You can also report an incident or unsafe product by calling toll-free at 1-800-638-8095 or by sending an e-mail to email@example.com
CPSC does not have jurisdiction over automobiles, trucks and motorcycles, car seats protecting children in on-road vehicles, foods, medicines, cosmetics, and medical devices, or dissatisfaction with business practices (links to the proper agencies can be found on the "Report Unsafe Products" page).
When filling out the form, use the TAB key or your mouse to go to the next data area. Use the scroll bar to scroll down the form. Please note that the "Source of Report" field must be changed from "Please Select".
This information is collected by authority of 15 U.S.C. 2054 and will be entered into a database by a Consumer Product Safety Commission contractor. The information is not retrievable by name. The information may be shared with product manufacturers, distributors, or retailers. However, no names or other personal information will be disclosed without explicit permission.
OMB Control Number 3041-0029