Questions for Depositions, Statements, and Trial

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Text in this Example:

Fill name:
Current residence:
How long:
Residence on date of accident:
Age:
Marital status (then and now):
Children:
Employment on date of accident:
Where:
Duties:
Do you recall being involved in an accident on....:
Time of day:
am/pm
Day of week:
Who was driving:
Passengers:
Where were you seated:
What happened (narrative):
What did you see:
Did you know you were going to be hit:
Lanes of street:
Amount of traffic:
Divided highway
Parking on sides of street:
Which way do the streets run:
How fast were you traveling:
How fast was the other car traveling:
Which direction each traveling:
Questions for Depositions, Statements, and Trial
Turn signals:
Traffic controls:
Which part of the vehicles impacted each other:
What happened to your car upon impact:
Which way did vehicle spin:
Where did each stop:
What did you do after it stopped:
Where did your journey begin:
Where were you doing:
Purpose of trip:
When due to arrive:
Lightning:
Weather:
Slope of street:
Alcohol/Drugs:
All conversation at the scene:
Used horn or other warning device:
Skid marks:
When did police arrive:
Who called:
Conversation with police:
Radio:
Windshield wipers:
Windows:
Defroster:
Child in car:
Date of last eye examination:
Wearing glasses/contacts:
Car phone:
Stick shift/automatic transmission:
Smoking/eating (hands on wheel):
Where was the sun:
Wearing sunglasses:
Witnesses:
Who owned the car:
When was the car purchased:
Borrowed from owner:
Type of vehicle:
Where licensed to drive:
Since when:
Restrictions:
License ever suspended or revoked:
Describe other car:
Mechanical condition of your car:
Where and when was it last inspected:
What, if anything, happened to your body at the moment of impact:
What part of your body came into contact with the vehicle:
How did you feel at the moment of impact:
Seat belt:
Where you injured as a result of the accident:
What portion of your body came to your attention at the scene:
Investigation of accident:
What did you do about your injuries:
Emergency Room:
How did you get there:
Type of pain (sharp or dull, constant or intermittent):
What was done for you at ER:
Medication:
Orthopedic appliances:
When did you arrive at and leave the hospital:
arrived at
left at
How did you feel the next morning:
Did you go back to work that day:
Did you go anywhere else for treatment:
Why:
Purpose of visits:
Used ER equipment until first doctor's visit:
Family doctor:
Who referred:
Result of first doctor's visit:
What was complained of:
What was done on subsequent visits:
Describe treatment/therapy:
Exercises:
Whirlpool:
Where were exercises performed:
Did they bring relief:
For how long did you see this doctor:
How many times (total):
How many times per week:
What other doctor saw you:
Who referred you:
Specialists seen:
Medication - side effects:
When was the last medical treatment:
How did you feel then:
How have you felt since then:
How do you feel today:
How many days a week do you feel pain - what do you do for it:
Did pain lessen at any point in treatment:
When (for each injury):
Were you ever able to resume normal daily activities:
When:
Household duties:
Sports:
Driving:
Sleeping:
Social activities:
Marital difficulties:
How did you feel before accident:
Prior accidents:
How long were you treated:
Injuries:
How long before accident had you recovered:
Later accidents:
Next scheduled work after date of accident:
Did you go to work:
Work schedule:
Date that you returned to work:
Average weekly wage:
Why did you not stay home from work:
After you went back to work, was there any limitation because of the accident:
Inability to do job:
Where you carrying anything:
Describe your shoes:
Describe your clothing:
Which foot slipped:
Describe your fall:
What parts of your body hit the ground:
What caused you to fall:
Where were you looking
When had you last been to the scene of the accident:
Were you aware of the defect that caused your fall:
Did you have an alternate route: