VF-2805. Injury Caused by Co-Employee's Intoxication (Lab. Code, § 3601(a)(2))
We answer the questions submitted to us as follows:
1. Was [name of plaintiff] harmed?
______ 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]'s conduct a substantial factor in causing [name of plaintiff]'s harm?
______ 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] intoxicated?
______ 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. Was [name of defendant]'s intoxication a substantial factor in causing [name of plaintiff]'s harm?
______ Yes ______ No
If your answer to question 4 is yes, then answer question 5. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form.
5. 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 $______
| 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. 2812, Injury Caused by Co-Employee's Intoxication (Lab. Code, § 3601(a)(2))—Essential Factual Elements.
If specificity is not required, users do not have to itemize all the damages listed in question 5 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)