VF 2802. Employers Defective Product (Lab. Code, § 3602(b)(3))

VF-2802. Employer's Defective Product (Lab. Code, § 3602(b)(3)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. Was the [product] manufactured by [name of defendant]? ____ 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 the [product] [sold/leased/transferred for valuable consideration] to an independent third person? ____ 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 the third person then provide the product for [name of plaintiff]'s use? ____ 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 the [product] defective in design or manufacture? VF-2802. Employer's Defective Product (Lab. Code, § 3602(b)(3)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 ____ Yes ____ No If your answer to question 4 is yes, then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. Was the [product] 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 [lost earnings [lost profits [medical expenses [other past economic loss Total Past Economic Damages: [b. Future economic loss $ $ $ $ $ ] ] ] ] ] VF-2802. Employer's Defective Product (Lab. Code, § 3602(b)(3)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 [lost earnings [lost profits [medical expenses [other future economic loss $ $ $ $ ] ] ] ] ] ] ] ] ] Total Future Economic Damages: $ [c. [d. [c. [d. Past noneconomic loss, including [physical pain/mental suffering:] Future noneconomic loss, including [physical pain/mental suffering:] Past noneconomic loss, including [physical pain/mental suffering:] Future noneconomic loss, including [physical pain/mental suffering:] TOTAL Signed: Dated: After [this verdict form has/all verdict forms have] been signed, notify the Presiding Juror $ $ $ $ $ VF-2802. Employer's Defective Product (Lab. Code, § 3602(b)(3)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 [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