VF-3034. Sexual Harassment in Defined Relationship (Civ. Code, § 51.9) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. Did [name of plaintiff] have a business, service, or professional relationship with [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. [Did [name of defendant] make [sexual advances/sexual solicitations/sexual requests/demands for sexual compliance/ [insert other actionable conduct]] to [name of plaintiff]?] [or] [Did [name of defendant] engage in [verbal/visual/physical] conduct of a [sexual nature/hostile nature based on gender]?] ____ 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. Was [name of defendant]'s conduct unwelcome and also pervasive or severe? VF-3034. Sexual Harassment in Defined Relationship (Civ. Code, § 51.9) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 ____ Yes ____ No If your answer to question 3 is yes, then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 [name of plaintiff] unable to easily end the relationship with [name of defendant]? ____ 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. Has [name of plaintiff] suffered or will [he/she] suffer [economic loss or disadvantage/personal injury/the violation of a statutory or constitutional right] as a result of [name of defendant]'s conduct? ____ 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 VF-3034. Sexual Harassment in Defined Relationship (Civ. Code, § 51.9) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 [lost earnings [lost profits [medical expenses [other past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. Past noneconomic loss, including [physical pain/mental suffering:] $ $ $ [d. Future noneconomic loss, including [physical pain/mental suffering:] TOTAL VF-3034. Sexual Harassment in Defined Relationship (Civ. Code, § 51.9) 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 [Answer question 7. 7. Signed: 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. _____________________________________________________________________________ What amount do you award as punitive damages? $ Presiding Juror ] New September 2003; Revised April 2007, April 2008, December 2010; Renumbered from CACI No. VF-3014 December 2012; Revised December 2016