LITHIUM-ION BATTERY FIRE DATA COLLECTION FORM

This is the data collection form for Lithium Ion (LI) Battery fires in the State of New Jersey. Information will be shared with contributing departments statewide on a regular basis and be used to identify trends and potential safety risks. This information can be shared as public safety awareness to reduce the risk of lithium-ion battery fires and guide safety regulations and training for firefighter and the public.

If you have any questions about the form or how your data will be used, please contact the data collection administrator, New Jersey Division of Fire Safety 609-468-6619.

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1. Submitter's Name *

2. Submitter's Agency *

3. Submitter's Email Address *

4. Please provide your department incident number *

Incident number will be used as a point of reference if we contact you and to ensure there are no duplicate entries in the database.

5. Incident Date *

Incident Address:

Street Address *

City *

County *

Zip Code *

6. Was the LI Battery Installed in a device? *

7. Was this the original LI Battery or a replacement? *

8. Was the battery or device UL Listed? *

9. Please provide the LI battery make/model (if known) *

10. Was the LI battery indoors or outdoors at the time of the incident? *

10a. If the LI battery was outdoors, was it in the sunlight? *

11. Was LI Battery charging at the time of the incident? *

12. Was the LI battery primarily stored indoors or outdoors? *

13. Were there other ignition sources in the area of origin? *

14. Were other ignition sources ruled out? *

If other:

15. Was the battery impacted by a fire from another source? *

16. What type of device(s) did the LI battery power? (Select ALL that apply) *

Micro Mobility Device (e-bike, hoverboard, scooter)

Portable Electronics (smartphone, tabletop, laptop, camera etc.)

Electric Vehicle (car, not RC toy car, bus, etc.)

Energy Storage System (Tesla wall, LG battery wall, etc.)

Remote Powered (drone, RC (toy) car, plane or boat)

Medical Device (hearing aid, wheelchair)

Power tools and equipment (drill, saw, lawn mower)

Other: Other:

16a. If electric vehicle, please provide make and model. *

17. Was there thermal runaway reported at the time of the incident? *

18. Was there structural involvement as a result of the fire? *

18a. If yes, please select structure type. *

If other:

19. Were there any injuries or fatalities as a result of the fire? *

If other:

20. Please give a brief explanation of the fire incident. *

If you have any photos that would be helpful for safety or educational purposes, please email them to: Vincent.campagna@dca.nj.gov