CACI No. VF-2803. Removal or Noninstallation of Power Press Guards (Lab. Code, § 4558)
Judicial Council of California Civil Jury Instructions (2023 edition)
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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]?
1. Yes No
1. 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?
2. Yes No
2. 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] give an affirmative instruction to [remove/
not install] the guards before [name of plaintiff]’s injury?
3. Yes No
3. 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. When [name of defendant] did so, did [he/she/nonbinary pronoun/it]
actually know that the lack of guards would create a probability
of serious injury or death?
4. Yes No
4. 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. 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]?
5. Yes No
5. 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.
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6. Was [name of defendant]’s [removal/failure to install] the guards a
substantial factor in causing harm to [name of plaintiff]?
6. Yes No
6. 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 are [name of plaintiff]’s damages?
[a. Past economic loss
[lost earnings $ ]
[lost profits $ ]
[medical expenses $ ]
[other past economic loss $ ]
[a. Total Past Economic Damages: $ ]
[b. Future economic loss
[lost earnings $ ]
[lost profits $ ]
[medical expenses $ ]
[other future economic loss $ ]
[b. Total Future Economic Damages: $ ]
[c. Past noneconomic loss, including [physical
pain/mental suffering:] $ ]
[d. Future noneconomic loss, including [physical
pain/mental suffering:] $ ]
[d. TOTAL $
Signed: Presiding Juror
Dated:
After [this verdict form has/all verdict forms have] been signed, notify
the [clerk/bailiff/court attendant] that you are ready to present your
verdict in the courtroom.
New September 2003; Revised April 2007, December 2010, December 2011,
December 2016
WORKERS’ COMPENSATION VF-2803
163
Directions for Use
This verdict form is based on CACI No. 2804, Removal or Noninstallation of Power
Press Guards - Essential Factual Elements.
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.
If specificity is not required, users do not have to itemize all the damages listed in
question 7 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.
If there are multiple causes of action, users may wish to combine the individual
forms into one form. If different damages are recoverable on different causes of
action, replace the damages tables in all of the verdict forms with CACI No. VF-
3920, Damages on Multiple Legal Theories.
If the jury is being given the discretion under Civil Code section 3288 to award
prejudgment interest (see Bullis v. Security Pac. Nat’l Bank (1978) 21 Cal.3d 801,
814 [148 Cal.Rptr. 22, 582 P.2d 109]), give CACI No. 3935, Prejudgment Interest.
This verdict form may need to be augmented for the jury to make any factual
findings that are required in order to calculate the amount of prejudgment interest.
VF-2803 WORKERS’ COMPENSATION
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© Judicial Council of California.
