VF 3021. Violation Of Prisoners Federal Civil Rights Eighth Amendment Substantial Risk Serious Harm

VF-3021. Violation of Prisoner's Federal Civil Rights--Eighth Amendment-- Substantial Risk of Serious Harm (42 U.S.C. § 1983) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. While imprisoned, [describe violation that created risk of serious harm, e.g. was [name of plaintiff] placed in a cell block with rival gang members]? ____ 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. Did [name of defendant]'s conduct create a substantial risk of serious harm to [name of plaintiff]'s health or safety? ____ 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] know that [his/her] conduct created a substantial risk of serious harm to [name of plaintiff]'s health or safety? ____ 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 VF-3021. Violation of Prisoner's Federal Civil Rights--Eighth Amendment-- Substantial Risk of Serious Harm (42 U.S.C. § 1983) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 presiding juror sign and date this form. 4. Was there a reasonable justification for the conduct? ____ 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 [name of defendant] acting or purporting to act in the performance of [his/her] official duties? ____ 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. Was [name of defendant]'s conduct a substantial factor in causing harm to [name of plaintiff]? ____ Yes ____ No 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. VF-3021. Violation of Prisoner's Federal Civil Rights--Eighth Amendment-- Substantial Risk of Serious Harm (42 U.S.C. § 1983) 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 7. 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 [lost earnings [lost profits [medical expenses [other future economic loss $ $ $ $ ] ] ] ] ] ] $ $ $ $ $ ] ] ] ] ] Total Future Economic Damages: $ [c. [d. Past noneconomic loss, including [physical pain/mental suffering:] Future noneconomic loss, including $ VF-3021. Violation of Prisoner's Federal Civil Rights--Eighth Amendment-- Substantial Risk of Serious Harm (42 U.S.C. § 1983) 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 [physical pain/mental suffering:] 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, June 2011; Renumbered from CACI No. VF-3008 December 2012; Revised June 2015, December 2016