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What kind of product was involved?

Describe the product(optional)

What happened?

Which state did it happen in?

When did it happen? (approximate is fine)

Brand and model(optional)

e.g. as printed on the device or box

Battery model or label, if known(optional)

How was it obtained?

Where was it bought?(optional)

Store or website

Which rental or fleet service?(optional)

Approximate purchase date(optional)

Have you seen a recall or safety warning for this product?

What do you remember about it?(optional)

What was the product doing at the time?

Which charger was used?

Did a fire department respond?

Department or report number, if known(optional)

Was there property damage?

In your own words, what happened?

Was anyone hurt?

Was there hospital or emergency treatment?

Is treatment ongoing?

Do you still have the product, battery or charger?

Who has it now?(optional)

e.g. fire department, insurer, landlord, fleet operator

Do you have photos or video?

Full name

Email

Phone

Best way to reach you