CJI-Civ. 4:20

You are instructed to answer the following questions. You must apply the law in the

instructions that the Court gave you to the facts that were proved by the evidence. You must all agree

on your answer to each question and you must all sign the completed form on the signature lines.

ANSWERS

We, the jury, present our answers to questions submitted by the Court, to which we have all

agreed:

(INSERT TITLE OF [FIRST] CLAIM AGAINST FIRST DEFENDANT

1. Do you find in favor of the plaintiff, (name), and against the defendant, (name of the first

defendant), on (insert applicable pronoun) claim of (insert appropriate description, e.g., “negligence,”

“breach of the warranty of. . . ,” etc.) under Instruction No. (insert the number assigned in the case to

the instruction that sets forth the basic elements of liability for the claim)? (Yes or No)

ANSWER: _____

Insert title[s] of claim[s] and additional separately numbered similar paragraphs with the titles of

applicable claims, so as to include all claims being made against the first defendant.)

(INSERT TITLE OF [FIRST] CLAIM AGAINST SECOND DEFENDANT

2. Do you find in favor of the plaintiff, (name), and against the defendant, (name of second

defendant), on (insert applicable pronoun) claim of (insert appropriate description, e.g., “negligence,”

“breach of the warranty of. . . ,” etc.) under Instruction No. (insert the number assigned in the case to

the instruction that sets forth the basic elements of liability for the claim)? (Yes or No)

ANSWER: _____

Insert additional separately numbered similar paragraphs with the titles of applicable claims, so as to

include all claims being made against the second defendant.)

If you answered all of the above questions “No,” then STOP HERE, go to the end of this

Verdict Form, and sign as indicated.

If, on the other hand, you answered “Yes” to any or all of the above questions, THEN

ANSWER THE FOLLOWING QUESTIONS.

(Note: examples for cases in which special interrogatories are appropriate instead of these general verdict

questions are in the boxes directly below.)

NEGLIGENCE

Answer each of the questions below concerning the claim of the plaintiff, (name), for

negligence under Instruction No. (insert the number assigned in the case to the instruction that sets

forth the basic elements of liability for the claim):

a. Did the plaintiff, (name), have (injuries) (damages) (losses)? (Yes or No)

ANSWER: _____

b. Was the defendant, (name of first defendant), negligent? (Yes or No)

ANSWER: _____

c. Was the defendant’s negligence, if any, a cause of the (injuries) (damages) (losses)

claimed by the plaintiff? (Yes or No)

ANSWER: _____

If you answered any of the above questions “No,” then you must find for the defendant on

the plaintiff’s claim for negligence, and you do not need to answer any of the following questions

with respect to that claim.

If, on the other hand, you answered “Yes” to all of the above questions, THEN ANSWER

THE FOLLOWING QUESTIONS.

BREACH OF CONTRACT

Answer each of the questions below concerning the claim of the plaintiff, (name), for breach

of contract under Instruction No. (insert the number assigned in the case to the instruction that sets

forth the basic elements of liability for the claim):

a. Did the defendant, (name), enter into a contract with the plaintiff to (insert the alleged

promise on which plaintiff is suing)? (Yes or No)

ANSWER: _____

b. Did the defendant fail to (insert the alleged promise on which the plaintiff is suing)? (Yes

or No)

ANSWER: _____

c. Did the plaintiff, (name), [substantially] perform [insert applicable pronoun] part of the

contract) (or) (Is the plaintiff, (name), excused from performance of [insert applicable pronoun] part

of the contract because [insert facts that, if proven, would as a matter of law justify non-performance])?

(Yes or No)

ANSWER: _____

If you answered any of the above questions “No,” then you must find for the defendant on

the plaintiff’s claim for breach of contract, and you do not need to answer any of the following

questions with respect to that claim.

If, on the other hand, you answered “Yes” to all of the above questions, THEN ANSWER

THE FOLLOWING QUESTIONS.

(3. Was the plaintiff, (name), (negligent) (or) (at fault) in causing (insert applicable pronoun)

own (injuries) (damages) (losses) as set forth in Instruction No. (insert the number assigned in the case

to the instruction that sets forth the basic elements of any form of comparative negligence or fault)? (Yes

or No)

ANSWER: _____)

(Insert, as shown above in question 3, additional separately numbered similar paragraphs so as to include

other defenses to the plaintiff’s claims.)

(4. Was (name or appropriate description of [first] designated nonparty) (negligent) (or) (at fault)

in causing the plaintiff’s (injuries) (damages) (losses) as set forth in Instruction No. (insert the number

assigned in the case to the instruction that sets forth the basic elements of any form of nonparty negligence

or fault)? (Yes or No)?

ANSWER: _____)

(Insert additional separately numbered similar paragraphs for any other designated nonparties.)

5. State the total amount of the plaintiff’s damages[, without considering the percentages of

(negligence) (and) (or) (fault) of any of the parties (or nonparties).] The categories of damages or

losses are described in Instruction No. __.

a. What is the total amount of the plaintiff’s damages, if any, for noneconomic losses or

injuries? Noneconomic losses or injuries are those losses or injuries described in

paragraph 1 of Instruction ___. You should answer “0” if you determine there were

none.

ANSWER: $_______

b. What is the total amount of the plaintiff’s damages, if any, for economic losses?

Economic losses are those losses described in numbered paragraph 2 of Instruction

No.___. You should answer “0” if you determine there were none.

ANSWER: $_______

c. What is the total amount of the plaintiff’s damages, if any, for physical impairment or

disfigurement? In computing damages in this category, you shall not include any

damages for losses or injuries already determined above. You should answer “0” if you

determine there were none.

ANSWER: $_______

(Note: an example for damages questions in a property damage case is below.)

(Alternative or additional language for claims involving property damage)

State below the amount of dollars that will compensate the plaintiff for (insert applicable

pronoun) damages, as set forth in Instruction No. ____.

a. Reasonable repair and/or replacement costs, if any:

ANSWER: $__________

b. Other reasonable costs or losses, if any:

ANSWER: $__________

c. The decrease in market value of the property, if any, as repaired:

ANSWER: $__________

(Alternative or additional language for claims involving breach of contract)

State below the amount of dollars that will compensate the plaintiff for (insert applicable

pronoun) damages that were the natural and probable consequences of the defendant’s breach of

contract and that the defendant reasonably could have foreseen at the time the parties entered into

the contract could probably occur if the defendant breached the contract, as set forth in Instruction

No. ____.

a. (Insert proper measure of general damages that have been proved depending on the kind of

contract involved), if any:

ANSWER: $__________

b. (Insert the proper measure of any recoverable special damages that have been proved), if

any:

ANSWER: $__________

(6. Taking as 100 percent the combined (negligence) (or) (fault) that caused the plaintiff’s

(injuries) (damages) (losses), what percentage of the plaintiff’s damages was caused by the

(negligence) (or) (fault), if any, of:

a. The plaintiff; (and)

b. Each of the defendants from whom you have found the plaintiff is entitled to recover; (and)

c. (The designated nonparty) (Any one or more of the designated nonparties).

You must enter “0” for any party and designated nonparty you have found was not

(negligent) (or) (at fault).

ANSWER:

Percentage, if any, charged to the plaintiff, (name): ___ %

Percentage, if any, charged to defendant, (name of first defendant): ___%

Percentage, if any, charged to defendant, (name of second defendant): ___%

Percentage, if any, charged to designated nonparty, (name of first

designated nonparty): ___%

Percentage charged to designated nonparty, (name of second

designated nonparty): ___%

MUST TOTAL: 100%)

(7. Do you find that the plaintiff has proved beyond a reasonable doubt (insert applicable

pronoun) claim for punitive damages against the defendant, as set forth in Instruction No. ___? (Yes

or No)

ANSWER:______

If you answered this question “No,” then sign the verdict form. If you answered “Yes,” state

the amount of punitive damages that you determine the plaintiff should recover.

ANSWER: $_____)

Please sign this form. If any verdict forms for other plaintiffs remain unanswered, complete

them.

Foreperson