Phone Safety Incident Report Form
Please provide details about the phone-related safety incident to help us improve safety and prevent future occurrences.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Model or Device Type
*
Date of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Incident
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Type of Incident
*
Please Select
Overheating
Battery Swelling
Smoke or Fire
Electric Shock
Physical Damage
Other
Describe the Incident
*
Actions Taken After the Incident
Upload Photo or Evidence (if available)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Report
Should be Empty: