Record your report

Describe what happened, the product, and your contact details. Stop recording to fill the form. You can also type below.

One recording can fill multiple parts of the form.

Audio and drafts are saved in this browser. Filling the form sends transcript text to OpenCode (GLM 5.3 Flash) via Cloudflare for interpretation. Browser dictation may also send audio to your browser vendor. Internet is required. Up to 5 minutes per recording. Review every filled value.

Paste or record your report

Paste a transcript to fill empty incident, product, and contact fields. You can edit it and fill the fields again. Contact details stay separate from the incident description.

What happened & the product

I am a / I am affiliated with *

I am reporting * A hazardous incidentAn incident or injury involving an unsafe product. A safety concernA product that could cause an incident or injury.

Describe the incident or safety concern *

Include how the product was used, what happened, and any injuries. Leave out names and contact details.

Review your description before continuing.0 characters

When did this happen? *This is an approximate date

Where did this happen?

Add the incident address

Street address

City

State / Province

Postal code

Country

Tell us about the product

Labels, packaging, or a receipt can help identify the product. Fill in what you know.

Product description *

Include the product name and what it is used for.

Product category

Brand name

Model name or number

Serial number

Manufacturer / Private labeler

Purchased from

Purchase dateThis is an approximate date

More product information

UPC / Barcode

Date manufactured

Manufacturer address

Do you still have the product?

Have you contacted the manufacturer?

Was the product damaged before the incident?

Was the product modified or repaired before the incident?

Photos and documents

Optional. Up to 5 JPG, PNG, WebP, or PDF files, 2 MB total. Files stay in your local draft and JSON export.

Your contact information

This demo saves these details in this browser. Use sample details when demonstrating it.

Your age group *

First name *

Last name *

Provide an email address or a phone number, or both.

Phone

My contact address is the same as the incident address

Street address *

City *

State / Province

Postal code

Country *

Report permissions

These selections are included in your local report file.

May CPSC publish the report without your name and contact information? *

YesNo

May CPSC share your name and contact information with the manufacturer? *

YesNo

Record your report

What happened & the product

Tell us about the product

Your contact information

Report permissions

Review your report

Demo

Fictional incident · read aloud while recording

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