VF-2803. Removal or Noninstallation of Power Press Guards (Lab. Code, § 4558)

We answer the questions submitted to us as follows:

1. Was [name of defendant] [name of plaintiff]'s [employer/ supervisor]?

______ 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 plaintiff] injured while operating a power press?

______ 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. Did [name of defendant] [remove/fail to install] [authorize the [removal of/failure to install]] the guards knowing that this would create a probability of serious injury or death?

______ 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. Did the power press's [designer/fabricator/assembler] [design the press with guards/install guards on the press/ require guards be attached/specify that guards be attached] and directly or indirectly convey this information to [name of defendant]?

______ Yes  ______ No

If your answer to question 4 is yes, then answer question 5. If you answered no, stop here, answer no further uestions, and have the presiding juror sign and date this form.

5. Was [name of defendant]'s [removal/failure to install] the guards a substantial factor in causing harm to [name of plaintiff]?

______ 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. What are [name of plaintiff]'s damages?

[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 $______

[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. 2804, Removal or Noninstallation of Power Press Guards (Lab. Code, § 4558)—Essential Factual Elements.

If specificity is not required, users do not have to itemize all the damages listed in question 6 and do not have to categorize "economic" and "noneconomic" damages, especially if it is not a Proposition 51 case. The breakdown of damages 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.

(New September 2003)