IN THE CIRCUIT COURT OF ____________ COUNTY, ____________
NAME OF PLAINTIFF )
)
)
V. ) NO.
)
)
NAME OF DEFENDANT )
)
)
COMPLAINT
Comes now _____________, Plaintiff in the above styled and numbered cause and files
this his Complaint against _____________, Defendant, and in support thereof would show unto
the Court the following facts, to wit:
1. That the Plaintiff is an adult resident citizen of _________ County, _________.
2. That the Defendant is a resident corporation under the laws of one of the several
states of the United States as a common carrier by rail; and for the purpose hereof did operate
locomotives, railroad cars and repair facilities and transacted substantial business in and about
the State of _________, and may be served with process by serving its registered agent
_________, _________, (address).
3. That the Plaintiff has been employed for several years with _________ in _________
County, _________. The Plaintiff was engaged in the performance of his duties as an employee
of _________ at the time in which he was injured as hereinafter alleged.
4. That during the course of the Plaintiff's employment, _________ was engaged in
interstate commerce as a common carrier by rail, and all or part of the duties of Plaintiff wee in
furtherance of and did closely, directly and substantially affect interstate commerce; wherefore
the rights and liabilities of the parties were and are governed by the Federal Employers' Liability
Act, 45 U.S.C., Section 1, et seq., which Act grants this Court jurisdiction over this action.
5. That during the Plaintiff's term of employment with Defendant, he has been subjected
to excessive, constant and extremely loud levels of noises throughout his daily work period,
caused by various machines and machinery owned and operated by Defendant, ultimately
resulting in Plaintiff sustaining severe and permanently disabling hearing loss.
6. That the Plaintiff was exposed to hazardous and unhealthy work conditions with no
adequate testing, monitoring, protection or relief provided by the Defendant.
7. The Defendant was careless, reckless and negligence in the following ways, to wit:
(a) Defendant failed to exercise due care in providing Plaintiff with a reasonably
safe and healthy work environment;
(b) Defendant failed to take reasonably adequate precautionary steps to protect
Plaintiff from reasonably foreseeable danger;
(c) Defendant failed to provide Plaintiff with an adequate in - house safety
training program;
(d) Defendant failed to protect Plaintiff from extremely loud and excessive noise
levels through the use of personal protective equipment;
(e) Defendant failed to warn Plaintiff of the potential risk and hazards associated
with extreme and constant high levels of noise;
(f) Defendant failed to adequately administer a continuing hearing conservation
program;
(g) Defendant failed to conform to the occupational safety and health standards
promulgated under the Occupational Safety and Health Act of 1970; the Federal Railway
Administration and the Walsh - Healey Act of 1969; and,
(h) Any and all other acts of negligence as may be brought out at the trial of this
cause.
8. That the Plaintiff's injuries were also caused and/or furthered as a proximate result of
numerous misrepresentations made by Defendant to Plaintiff. Defendant additionally withheld
and concealed vital information regarding Plaintiff's condition to the further detriment of
Plaintiff. The Defendant failed to exercise reasonable care and/or competence in obtaining and
communicating such false information and in withholding and concealing such information. The
Defendant intended that Plaintiff rely upon information communicated to Plaintiff by Defendant
and Plaintiff did, in fact, rely upon such information.
9. That as a direct and proximate result of the aforementioned conduct of the Defendant
he has sustained severe permanently disabling injuries resulting in extreme hearing loss, loss of
balance, neurological injuries and permanent ringing in his ears. As a result of the injuries
sustained by Plaintiff, he has undergone medical treatment to those portions of his body
adversely affected.
10. That the Plaintiff has suffered, and because such injuries are permanent in nature,
will in the future suffer pain, nervousness, mental anguish and emotional distress. That the
Plaintiff's sense of hearing has been permanently impaired, thereby adversely affecting his
ability and capacity to earn a living. Additionally, the injuries herein complained of have
irreversibly diminished the Plaintiff's ability to live and enjoy a normal life.
11. That the Plaintiff's ability to work in labor in the future has been severely and
permanently diminished. In this regard, the Plaintiff would show that he has suffered a decrease
in his future wage earning capacity. The Plaintiff also stated that he will sustain significant
medical expenses in the future, in the exact amount of which cannot be determined at this time.
WHEREFORE, Plaintiff demands judgment of and from the Defendant in the amount of
$00.00 and all costs of Court.
Respectfully submitted,
___________________________
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FAQs
Here is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.
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airSlate SignNow simplifies the Complaint Employee Form process by allowing users to create, send, and eSign documents easily. This platform not only ensures compliance with company policies but also speeds up the resolution of employee issues, fostering a healthier workplace environment.
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The best way to complete and sign your complaint employee form
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