VF-1204. Products Liability - Negligence - Plaintiff's Contributory Negligence at Issue
We answer the questions submitted to us as follows:
1. Did [name of defendant] [design/manufacture/supply/install/ inspect/repair/rent] the [product]?
______ Yes ______ No
If your answer to question 1 is yes, then answer question 2. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.
2. Was [name of defendant] negligent in [designing/ manufacturing/supplying/installing/inspecting/repairing/ renting] the [product]?
______ Yes ______ No
If your answer to question 2 is yes, then answer question 3. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.
3. Was [name of defendant]'s negligence a substantial factor in causing harm to [name of plaintiff]?
______ Yes ______ No
If your answer to question 3 is yes, then answer question 4. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.
4. What are [name of plaintiff]'s total damages? Do not reduce the damages based on the fault, if any, of [name of plaintiff].
| [a. Past economic loss, including [lost earnings/ lost profits/medical expenses:] | $______] |
| [b. Future economic loss, including [lost earnings/lost profits/lost earning capacity/ medical expenses:] | $______] |
| [c. Past noneconomic loss, including [physical pain/mental suffering:] | $______] |
| [d. Future noneconomic loss, including [physical pain/mental suffering:] | $______] |
| TOTAL $______ |
If [name of plaintiff] has proved any damages, answer question 5. If [name of plaintiff] has not proved any damages, then stop here, answer no further questions, and have the presiding juror sign and date this form.
5. Was [name of plaintiff] negligent?
______ Yes ______ No
If your answer to question 5 is yes, then answer question 6. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.
6. Was [name of plaintiff]'s negligence a substantial factor in causing [his/her] harm?
______ Yes ______ No
If your answer to question 6 is yes, then answer question 7. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.
7. What percentage of responsibility for [name of plaintiff]'s harm do you assign to:
| [Name of defendant]: | ______% |
| [Name of plaintiff]: | ______% |
| TOTAL | 100 % |
| Signed: | |
| Presiding Juror | |
| Dated: |
[After it has been signed/After all verdict forms have been signed], deliver this verdict form to the [clerk/bailiff/judge].
Directions for Use
The special verdict forms in this section are intended only as models. They may need to be modified depending on the facts of the case.
This verdict form is based on CACI No. 1220, Negligence—Essential Factual Elements, and CACI No. 405, Plaintiff's Contributory Negligence.
If specificity is not required, users do not have to itemize all the damages listed in question 4. The breakdown is optional; depending on the circumstances, users may wish to break down the damages even further.
If there are multiple causes of action, users may wish to combine the individual forms into one form.
This form may be modified if the jury is being given the discretion under Civil Code section 3288 to award prejudgment interest on specific losses that occurred prior to judgment.
(New September 2003)