To discuss the safety risk management measures for puffer fish from the investigation on an outbreak of puffer fish intoxication and a knowledge-attitude-practice (KAP) survey on the puffer fish safety.Methods The cases were searched and all of their family members were investigated on food exposure history. A cohort study was conducted to identify risk factors. A self-designed questionnaire was used for KAP investigation. Results 14 puffer fish poisoning cases (one case died) were identified. Clinical symptoms included dizziness (100%), weakness of limbs (79%), muscular paralysis of the limbs or walking difficulty (71%), orolingual numbness (71%), and so on. Eating poisonous puffer fish was the risk factor, and fish meat and fish liver cooked together was significantly associated with poisoning (RR=1.8,5%CI=1.1-3.1). The results of KAP showed that 70% (33/47) had puffer fish consumption in the last three years. 98% (46/47) knew the puffer fish was poisonous and 94% (44/47) knew the state law forbids eating puffer fish. Meanwhile 94% (44/47) of people considered the puffer a delicacy worth to eat. Conclusion This outbreak was caused by poisonous puffer fish consumption. Local residents had a high awareness of puffer safety, but a poor compliance to the prohibition of eating puffer fish.