Jury Questionnaire, Product Liability Cases

Excerpted from Building Trial Notebooks

§19.13 Form: Jury Questionnaire, Product Liability Cases

Confidential Questionnaire

Juror No.: ______1. Name: Age: 2. Where do you work and what is your job? If unemployed/retired, what was your last job? 3. What are/were your main job responsibilities? 4. What jobs have you held in the past? 5. Have you ever held a job that required you to see that safety regulations were followed?  Yes  No If yes, what kind of job was it, and how were safety regulations involved? 6. Have you ever purchased a product where you felt the instructions were inadequate?  Yes  No If yes, please explain: 7. What is the occupation of your spouse/partner? If unemployed/retired, what was this person’s last job? What jobs has this person held in the past? 8. Your parent(s) employment (if deceased or retired, list principal employment when working): 9. List your children’s employment or schools, if applicable: 10. What was the highest educational level completed by:

Juror Spouse Children Father Mother

Grammar School

High School

Some College

College Degree Post- Graduate Degree

11. If you had some college or graduated from college, what was your major and degree, if any? 12. Have you ever served in the Armed Forces?  Yes  No Years Served: Rank: Branch: 13. Have you attended any training, education, lectures, seminars or courses in any of the following areas? Check () all those that apply:  Accounting  Business  Home Safety  Rehabilitation  Traffic Accidents  Business Law  Insurance  Therapy  Physical Therapy  Chemistry  Law  Insurance Statistics  Engineering  Medicine  Finance  Automobile Safety  Psychology  Brain Injuries  Work Safety  None of the above 14. Have you, any family members or friends ever applied for work with, worked for, done business with, or owned stock in any insurance company?  Yes  No If yes, who, for what company(ies) and what was the relationship to the company? 15. Have you or any family members held a job that involved writing or reviewing claims?  Yes  No If yes, please explain: 16. Have you ever used or purchased a product that was defective?  Yes  No If yes, please explain: 17. Who should be responsible for seeing that a product is installed properly? Check () all those that apply:  Manufacturer  Wholesaler  Retail Store  Installer  Buyer  User  Other Please explain: 18. In general, what are your opinions or feelings about insurance companies? 19. Have you or any family members ever made a claim on an insurance policy?  Yes  No If yes, please explain: 20. Have you or any family member ever owned a business?  Yes  No If yes, what type of business, where and when? If the business is no longer open, why was it sold or closed? 21. Have you or anyone in your family ever hired attorneys, or worked for any attorneys or law firms?  Yes  No If yes, and they were in this state, which attorneys or law firms? 22. Do you know any attorneys on a personal basis?  Yes  No If yes, who do you know and how do you know this person? 23. Have you or anyone you know ever worked as a firefighter, paramedic or emergency medical technician?  Yes  No If yes, please explain: 24. Have you or any family members ever applied for work in any hospital, medical clinic, rehabilitation clinic, doctor’s office, or other medical facility?  Yes  No If yes, please explain: 25. Have you, any family members or close friends ever been a Plaintiff (the person suing) or a Defendant (the person being sued) in a lawsuit?  Yes  No If yes, please explain: 26. How many times have you served as a juror in a: Criminal case _____ times Civil case ____ times Never Served  Were you the foreperson?  Yes  No 27. Have you or anyone you know ever been seriously injured while in another person’s home or motor vehicle?  Yes  No If yes: Who was injured? What was the injury? What caused the injury? Was there a lawsuit(s) filed because of the injury?  Yes  No What was the outcome of the lawsuit? How did you feel about the outcome of the lawsuit? 28. Have you ever known anyone who was seriously injured but whose injuries were not visible or apparent?  Yes  No If yes, please tell us about that situation: 29. Have you ever had the responsibility of taking care of a family member or friend who was seriously injured?  Yes  No 30. Which of the following would you use to describe yourself? Check () all those that apply:  Analytical  Assertive  Athletic  Careful  Cautious  Compassionate  Compulsive  Creative  Decisive  Detailed  Determined  Emotional  Frugal  Generous  Impulsive  Judgmental  Leader  Logical  Naive  Not Talkative  Old-Fashioned  Open-Minded  Opinionated  Outspoken  Practical  Private  Pro-Company  Pro-Worker  Quiet  Religious  Selfish  Sensitive  Shy  Skeptical  Smart  Snap-Decision  Strict  Successful  Team Member  Technical  Thoughtful  Thrifty  Trusting  Visual  Worrier 31. Please list any unions or civic, social, professional, or religious organizations to which you now belong or have belonged: 32. In a case where a person slipped and fell at a grocery store because someone did not do his/her job of wiping up water, do you think the person should try to get money for his/her injuries?  Yes  No If yes, please explain: 33. How do you feel about the amount of money damages awarded in lawsuits today? Please check () your answer:  Much Too High  Somewhat High  About Right  Somewhat Low  Much Too Low 34. Are you or anyone in your family a member of CALA (Citizens Against Lawsuit Abuse) or any other group that wants to change laws about lawsuits?  Yes  No If yes, tell us which groups: 35. Please list the newspapers, magazines, professional journals, or periodicals which you subscribe to or read: 36. How many hours a week do you spend watching television? 37. List your three favorite TV programs: 1. 2. 3. 38. Name three people you admire. 1. 2. 3. 39. Please list the three people you admire least: 1. 2. 3. 40. Please list the one person you feel most influenced your life and tell us why: 41. What do you enjoy doing in your spare time? 42. What do you think about the number of lawsuits filed in recent years? Please check () your answer:  Much Too High  Somewhat High  About Right  Somewhat Low  Much Too Low 43. Who makes the financial decisions in your home? 44. Are you:  Very Conservative  Conservative  Moderate  Liberal  Very Liberal