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Questionnaire: When Injured By a Defective Product

One of the most important things your lawyer needs to know is when you were injured. While in many cases the day of this event is completely obvious, in some cases the answer is very subtle. If your injury cannot be linked to a specific accident on a specific date, this questionnaire will help your lawyer pin down this fact. The date of injury is extremely important. Your state has statutes that prevent you from making any recovery if too much time has passed between the date you were injured and the date you file your lawsuit. It is better to know right away if these statutes will affect your case.

As you complete this questionnaire, keep in mind that some of the questions may not apply to you. Read them carefully before you move on to the next question. Also, some of the questions are fairly technical, but do your best with them.

Available in PDF | MS Word

1. Does your legal claim arise out of a disease rather than an injury?


2. When did you discover that you were, in fact, injured?


3. If you suffered more than one injury, did they occur on different dates?


4. If you answered “Yes” to Question 3, on what dates did your injuries occur?

First injury__________________________

Second injury__________________________

Third injury__________________________

5. If you were injured in an accident involving a product or some equipment, when did you learn the identity of the manufacturer?_______________________________________________

6. If you were injured in an accident involving a product or some equipment, when did you first learn that the product was defective, or that the manufacturer was negligent in designing or manufacturing the product?_______________________________________________________

7. If you were injured by a long-term exposure to a substance, chemical, or product, when was the last time you were exposed to it? ____________________________________________

8. When you bought the product or equipment, did it come with any express warranties? (An express warranty is a specific promise about the product. It is not a general promise that it is “merchantable” or “fit for a particular purpose.”)


9. If you answered “Yes” to Question 8, did the manufacturer break that promise?


10. When you bought the product or equipment, did it come with any promise about its future performance?


11. If you answered “Yes” to Question 10, did the product live up to that promise?


12. Did the product or equipment have a concealed defect?


13. When you were injured, were you:

a. Under age 18?_______Yes_______No

b. Not in your right mind?_______Yes_______No

c. Severely ill?_______Yes_______No

d. In jail?_______Yes_______No

14. If you answered “Yes” to Question 13(b) or Question 13(c), please explain the circumstances.






15. At the time you were injured did anybody else do something that contributed to causing the accident or your injury?

_______Yes _______No

If you answered “Yes” please explain how: _________________________________________




Next Steps

Contact a qualified product liability attorney to make sure your rights are protected.

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