VF-2507A. Hostile Work Environment Harassment--Conduct Directed at Plaintiff--Individual Defendant (Gov. Code, � 12940(j)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. Was [name of plaintiff] [an employee of/a person providing services under a contract with] [name of employer]? ____ 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. Was [name of plaintiff] subjected to unwanted harassing conduct because [he/she] was [protected status, e.g., a woman]? ____ 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 the harassment severe or pervasive? ____ 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. VF-2507A. Hostile Work Environment Harassment--Conduct Directed at Plaintiff--Individual Defendant (Gov. Code, � 12940(j)) Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 4. Would a reasonable [e.g., woman] in [name of plaintiff]'s circumstances have considered the work environment to be hostile or abusive? ____ 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. Did [name of plaintiff] consider the work environment to be hostile or abusive? ____ 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. Did [name of defendant] participate in/assist/ [or] encourage] the harassing conduct? ____ 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-2507A. Hostile Work Environment Harassment--Conduct Directed at Plaintiff--Individual Defendant (Gov. Code, � 12940(j)) 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. Was the harassing 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. 8. 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 $ ] $ $ $ $ $ ] ] ] ] ] VF-2507A. Hostile Work Environment Harassment--Conduct Directed at Plaintiff--Individual Defendant (Gov. Code, � 12940(j)) 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 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 Signed: Dated: Presiding Juror 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. _____________________________________________________________________________ Derived from former CACI No. VF-2506 December 2007; Revised December 2010, June 2013, December 2016