Product Safety Questionnaire Form
Please complete the Product Safety Questionnaire Form to help us evaluate and improve product safety standards.
Product Name or Model
*
Product Category
*
Please Select
Electronics
Appliances
Toys
Furniture
Tools/Hardware
Personal Care
Other
How familiar are you with the safety instructions for this product?
*
1
2
3
4
5
Which of the following safety features are present on the product?
*
Warning labels
Child safety locks
Automatic shut-off
Protective casing
None of the above
Other
Has the product ever malfunctioned or caused an unsafe situation?
*
Yes
No
Not sure
If yes, please briefly describe the incident.
Do you believe the product meets current safety standards?
*
Yes
No
Not sure
How would you rate the overall safety of this product?
*
1
2
3
4
5
What improvements, if any, would you suggest for product safety?
Additional comments or observations
Submit
Should be Empty: