Portable Charger Incident Report Form
Please complete all sections of the Portable Charger Incident Report Form to help us accurately document and address incidents involving portable chargers.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Portable Charger Brand and Model
*
Type of Incident
*
Please Select
Overheating
Smoke
Fire
Swelling
Leakage
Other
Please describe the incident in detail
*
Were there any injuries or property damage?
*
No
Minor injury
Major injury
Property damage
Actions Taken Immediately After Incident
*
Upload a Photo or Supporting Document (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Incident Report
Should be Empty: