1. Model Form of Verdict for General Negligence With Apportionment of Fault Verdict We, the jury, return the following verdict: 1. Was there negligence on the part of (defendant) which was a legal cause of [loss] [injury] [or] [damage] to (claimant) (decedent)? Yes No If your answer to question 1 is NO, your verdict is for defendant, and you should not proceed further except to date and sign this verdict form and return it to the courtroom. If your answer to question 1 is YES, please answer question 2. 2. Was there negligence on the part of (claimant) (decedent) which was a legal cause of [his] [her] [loss] [injury] [or] [damage]? Yes No Please answer question 3. 3. Was there [negligence] [(specify other type of conduct)] on the part of (identify additional person or entity) which was a contributing legal cause of [loss] [injury] [or] [damage] to (claimant) (decedent)? Yes No [This question should be repeated, and the question numbers adjusted accordingly, for each additional person or entity as to which the evidence is sufficient to permit the jury to apportion fault.] Please answer question 4. 4. State the percentage of any negligence [or fault], which was a legal cause of [loss] [injury] [or] [damage] to (claimant) (decedent) that you charge to: (defendant) (identify additional person or entity) (claimant) __________% __________% __________% Total must be 100% (Note: For any response of "NO" to question 1, 2, or 3, place a zero as to that person [or entity] in answering question 4.) [If the evidence is sufficient to permit the jury to apportion fault to more than one additional person or entity, a separate line should be added for each such additional person or entity.] In determining the amount of damages, do not make any reduction because of the negligence, if any, of (claimant) (decedent) or the [negligence] [(specify other type of conduct)], if any, of (identify additional person(s) or entit(y)(ies))]. If you find that (claimant) (decedent) or (identify additional person(s) or entit(y)(ies)) [was] [were] negligent [or at fault], the court in entering judgment will make an appropriate reduction in the damages awarded. Please answer question 5. [Select the appropriate damage questions from forms 2[a] or [b].] SO SAY WE ALL, this day of __________, 2 _. ____________________________________ FOREPERSON