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Required Report Information

FEBRUARY 27, 2013

Summary Of Questions From 16 C.F.R. § 1115.13(D)
Full Report Information Requested


  1. The name, address, telephone and fax number, and title of the person submitting the “full report” information to the Commission.

  3. The name and address of the manufacturer (or importer) of the product and the addresses of the manufacturing plants for each product brand and series/models manufactured.  The country of origin (place of manufacture) of the product.

  5. An identification and description of the product(s).  Give retail prices, brand name, series/model numbers, and date codes, along with all information necessary to decipher the date codes.  Describe any identifying marks and their location on the product.  Please also provide the inclusive dates of manufacture for each product series.  Provide a picture or sample of the product.

  7. A description of the nature of the defect, failure to comply, or risk.  Provide copies of all technical drawings, test results, schematics, or diagrams, blueprints, catalogs or other graphic depictions of the products.

  9. The nature of the injury or possible injury associated with the product defect, failure to comply, or risk.

  11. The manner in which and the date when the information about the defect, noncompliance, or risk (e.g., complaints, reported injuries, quality control testing) was obtained.  If any complaints related to the safety of the product or any allegations or reports of injuries associated with the product have been received, copies of such complaints or reports (or a summary thereof) shall be attached.  Give a chronological account of facts or events leading to the report under section 15(b) of the CPSA, beginning with receipt of the first information which ultimately led to the report.  Also included may be an analysis of these facts or events.  Even if no defect, noncompliance, or risk is acknowledged, please provide copies of all claims (including warranty claims and reports from distributors, retailers, and service centers) and court complaints in which it is alleged that the subject product (i) malfunctioned; (ii) is defective; (iii) fails to comply with an applicable standard; (iv) presents a risk of injury; and/or (v) has caused or contributed to personal injury or death. If copies of consumer complaints and other documents requested above are unavailable, indicate the reason they are unavailable and provide a summary containing the names, addresses and telephone numbers of the consumers or of the plaintiffs' attorneys.
  12. The total number of products and units involved.

  14. The dates when products and units were manufactured, imported, distributed, and sold at retail.

  16. The number of products and units in each of the following: in the possession of the manufacturer or importer, in the possession of private labelers, in the possessions of distributors, in the possession of retailers, and in the possession of consumers.

  18. An explanation of any changes (e.g. designs, adjustments, and additional parts, quality control, testing) that have been or will be effected to correct the defect, failure to comply, or risk and other steps that have been or will be taken to prevent similar occurrences in the future together with the timetable for implementing such changes and steps.  Even if no defect, failure to comply, or risk is acknowledged, please provide a summary description of all design changes made to each model during it’s production and a copy of all engineering change notices.

  20. Information that has been or will be given to purchasers, including consumers, about the defect, noncompliance, or risk with a description of how this information has been or will be communicated.  This shall include copies of drafts of any letters, press releases, warning labels, or other written information that has been or will be given to purchasers, including consumers.

  22. The details of and schedule for any contemplated refund, replacement or repair actions, including plans for disposing of returned products (e.g. repair, destroy, return to foreign manufacturer).

  24. A detailed explanation and description of the marketing and distribution of the product from the manufacturer (including importer) to the consumer (e.g., use of sales representatives, independent contractors, and/or jobbers; installation of the product, if any, and by whom).
    • Where was the product sold? Nationally? Regionally (what area of the United States, Canada, and/or Mexico?) Was the product sold in Puerto Rico?

  26. Upon request the names and addresses of all distributors, retailers, and purchasers, including consumers.  At this time, please provide the names of distributors and retailer chains currently distributing or selling the subject product.

  28. In addition to providing the information requested above, see case opening or preliminary inquiry letter for item 15 questions.  Additional item (15) questions - The staff requests such further information necessary or appropriate to the functions of the Commission.  This information shall included but not be limited to:
    • Retail price of product.
    • Any product identification codes such as UPC codes.
    • If product is UL listed and the listing number.
    • All Standards and code requirements/listings that the product meets.
    • Was the product distributed or sold in Canada and/or Mexico?  If sold in Canada, has firm contacted Health Canada?  If sold in Mexico, has firm contacted Profeco?  Please give name, title, address, and phone number of person(s) contacted



(Name of Company) ____________________________.

I ___________________hereby certify that I am Chief Executive Officer of the above-named company and that as such I am authorized to sign documents and to certify on behalf of said company the accuracy and completeness of information in such documents.

            Pursuant to the power vested in me, I hereby delegate all or, to the extent indicated below, a portion of that authority to the person listed below.

            This delegation is effective until revoked in writing. Authority delegated to:





   Extent of authority:________________________





Report an unsafe product