Client interview questionnaire

Accidents and injuries resulting from dangerous conditions, activities or equipment on property or premises are generally classified as “premises liability” cases. These range from “slip and fall” cases to construction accidents; from playground equipment accidents to accidents in factories, plants and refineries; and from “attractive nuisance” cases such as swimming pool accidents and drownings to accidents in the “oilfield” (e.g., oil or natural gas drilling operations). The “prototypical” premises liability case is the “slip and fall case.” The following questionnaire is a standard interview questionnaire that a personal injury lawyer would walk through with a client who experienced a slip and fall accident.

Client Interview Questionnaire

The Slip and Fall Accident

1. Date of the accident: __________________________________________________

Day of the week: __________________________________________________

Time of day: __________________________________________________

Weather conditions: __________________________________________________

2. Describe in detail the location of the slip and fall accident.
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3. Describe in detail how the slip and fall accident occurred.
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4. Did you see any warnings, instructions, or signs giving notice of any dangerous conditions? If so, what did the warning or instructions say, or what did the sign depict?
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5. Give the name and address of the defendant(s) (include both owner and tenant of the property, if known).
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6. Give the name and address of defendant’s insurance carrier, and describe how you acquired this information.
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7. Give the name and address of defendant’s insurance adjuster, and describe how you acquired this information.
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8. List the names and addresses of all witnesses to the slip and fall accident.
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9. Was an ambulance called?_________________ If so, who called the ambulance, and when did it arrive? ___________________________________________________________

Did anyone accompany you to the hospital?______________ If so, give his or her name. ___________________________________________________________

10. Were you hospitalized?____________ If so, list the name and address of the hospital and the charges you incurred. ___________________________________________________________

11. List the names and addresses of all doctors, nurses and medical technicians who treated you, and their corresponding charges.
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12. Did you give any statements to any insurance company or to any other person about the slip and fall accident?______________ If so, when, where and to whom did you give the statement?
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13. Do you have a copy of the statement(s)?
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14. Has the defendant’s insurance carrier made any settlement offer to you? _______________ If so, when was the offer made, by whom and in what amount?
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15. Did the accident take place while you were working?
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16. Did the accident take place at your workplace?
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17. Were any co-workers involved? _________________ If so, list the names and addresses of co-workers involved and what their specific involvement was. ____________________________________________________________________________

18. Do you know whether any photographs, pictures, or films were taken of the scene of the accident? ___________ If so, when were they taken, and by whom? ____________________________________________________________________________

19. Do you have copies of any photographs, pictures, or films of the slip and fall accident?
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20. Were any photographs, pictures or films taken of you either at the scene of the slip and fall accident or in the hospital?_______________ If so, when were they taken, and by whom?
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Do you have copies? ____________________________________________________________________________

21. Are you aware of any actions taken to correct the condition which caused the accident/incident? _______________ If so, describe such actions and indicate who was responsible for such actions.
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