California Civil Jury Instructions (CACI) (2017)

VF-2901. Federal Safety Appliance Act or Boiler Inspection Act

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VF-2901.Federal Safety Appliance Act or Boiler Inspection Act
We answer the questions submitted to us as follows:
1. Was [name of plaintiff/decedent] employed by [name of defendant]?
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 defendant] a common carrier by railroad?
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. Was [name of defendant] engaged in interstate commerce?
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. Did [name of plaintiff/decedent]’s job duties further, or in any way
substantially affect, interstate commerce?
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. Was [name of plaintiff/decedent] acting within the scope of [his/
her] employment at the time of the incident?
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.
6. Did [name of defendant] [describe violation of Federal Safety
Appliance Act/Boiler Inspection Act]?
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
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have the presiding juror sign and date this form.
7. Was [name of plaintiff] harmed?
7. Yes No
7. If your answer to question 7 is yes, then answer question 8. If
you answered no, stop here, answer no further questions, and
have the presiding juror sign and date this form.
8. Was [name of defendant]’s conduct a cause of [[name of plaintiff]’s
harm/[name of decedent]’s death]?
8. Yes No
8. If your answer to question 8 is yes, then answer question 9. If
you answered no, stop here, answer no further questions, and
have the presiding juror sign and date this form.
9. 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 loss, including [physical
pain/mental suffering:] $ ]
[d. Future loss, including [physical
pain/mental suffering:] $ ]
[d. TOTAL $
Signed: Presiding Juror
Dated:
FELA VF-2901
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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 2016
Directions for Use
This form is based on CACI No. 2920, Essential Factual Elements—Federal Safety
Appliance Act or Boiler Inspection Act.
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.
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-2902–VF-2999. Reserved for Future Use
VF-2901 FELA
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