CSA Group - Product Recalls - Product Incident Report

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CSA Group's Corporate Mark Integrity (MI) team is an integral part of the CSA Group Legal Department located in our Corporate Office. The MI team investigates incidents involving CSA certified products, issues all points bulletins (APBs), product recalls and safety notices in co-operation with manufacturers and supports the standards development process.

Fill out the online form below and let us know about an incident with a CSA-certified product

You can also call CSA Group's Corporate Mark Integrity team at (416) 747-4278

* mandatory fields

Reported By:
1.	Contact Person:	*			first name / last name
2.	Company:		(if applicable)
3.	Street:	*	4.	Apt #
5.	City:	*
6.	Province/State:	*	7.	Postal/Zip Code:
8.	Country:	*
9.	Residence No:		10.	Business No:
11.	Cell Phone No:		12.	Fax No:
13.	Email Address:	*
14.	Incident Date:		mm/dd/yy
Product User: (if different from above)
1.	Contact Person:	*			first name / last name
2.	Company:		(if applicable)
3.	Address:	*	4.	Apt #
5.	City:
6.	Province/State:		7.	Postal/Zip Code:
8.	Country:
9.	Residence No:		10.	Business No:
11.	Cell Phone No:		12.	Fax No:
13.	Email Address:	*
14. * Please describe the incident below: (up to 2000 words)

Product Information:
1.	Product Description:	* (E.g. Modular Home, Kettle, Misleading Website Representation and/or Advertising)
2.	Is product CSA Marked? What does that mean?	* Yes No	3.	Is package CSA Marked?	Yes No
4.	Country of Manufacture:
5.	Where was the product used?	*
6.	CSA File Number: What does that mean?	* (This is the number that appears close, usually below, to the CSA Mark)
7.	Product Identification:	*		(E.g. Model/Series/Type)
8.	Serial Number:
9.	Date Code:			(Date of Manufacture)
10.	Manufacturer:	*
11.	Brand Name:
Incident Details:
1.	Does this case involve a web infringement?			Yes No
2.	Does this case involve advertising infringement?			Yes No
3.	Does this case involve Fire/Explosion?			Yes No
3.1	File Damage Type:
4.	Does this case involve injury?			Yes No
4.1	Injury Description:
5.	Has this been reported to a Regulatory Body?			Yes No Reference No:
* CSA International conducts investigations solely in support of our certification and standards writing process. I understand that CSA is not at liberty to release results of their investigations or the corrective action taken as they are considered confidential. By completing this form, I consent to CSA collecting and using the information provided by me on this form strictly to conduct investigations into the product incident described. If appropriate and applicable, i understand that it is my responsibilty to obtain the consent of individuals whose personal information I am disclosing to CSA. CSA is committed to protecting the privacy of the persoanl information in this form. This information is never sold to third parties by CSA. However, I understand and consent to CSA releasing any personal information contained on this form to manufacturers or regulatory authorities for the purpose of investigating a product incident (only to the extent required for such investigation); or to comply with a court order requiring release. Visit CSA’s Corporate Policy Confidentiality and Privacy at www.csagroup.org/legal/ for information on how CSA protects your personal information.