Elevator/Escalator Case Intake Form Section1
The device I was injured by was an:
The accident happened because the escalator:
This accident happened because the elevator:
Section2
The incident was reported to:
I have a copy of the incident report, if one was prepared:
I have pictures of the device that caused me to be injured:
Section3
The area of the accident had video cameras:
I have, or can get the name of, a witness to the accident:
After the accident, I sought medical or hospital care:
Section4
I injured my:
Section5
The injuries have caused me to:
Additional Information:
I understand that the transmission of this information does not create an attorney client relationship but is, instead, a request for a free consultation with an attorney about the details of my potential case.
Disclaimer