If you or a
family member have experienced a recent aquatic injury involving
a consumer product (e.g., diving board, pool cover, floatation
device, etc.), please provide the following information and press
the SUBMIT button. We will forward
this data to the Consumer Product Safety Commission.
In the space below, describe
the incident or hazard, including a description of injuries,
andprovide answers to the following questions:
Name of victim
(if different from above)
Victim's age at time of incident
Date of Incident
Describe product involved
Product Brand Name/Manufacturer
Is product involved still available?
Product model and serial number
When was the product purchased?
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for Aquatic Injury Prevention
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