This Claim Form for a Slip and Fall on Commercial Property is for use by an attorney representing a client or an individual who has incurred injuries from a slip and fall while on commercial business premises. This claim form will serve as formal notice of the injury and is sent to the business where the fall occurred. This form contains the pertinent information regarding the slip and fall including where it occurred, date of occurrence, the facility where treatment was received and names of treating physicians. It also contains a short description of the injured party and how the slip and fall has affected their life and livelihood. It is crucial that all details regarding this type of slip and fall injury be set out in writing. A written Claim Form after a Slip and Fall on Commercial Property will act as formal notice of a claim and be useful in the event litigation is filed.

This Claim Form – Slip and Fall (Commercial Property) includes the following:

• Business/Registered Agent: Sets out the name and address of the business where the injury occurred and the registered agent if the business is a corporation;
• Injury: Sets out a detailed description of the incident including the date, how the slip and fall happened and location in the business where the injury occurred;
• Treating Hospital/Physician: Sets out a description of treatment received, name of attending physician, medications prescribed and follow-up instructions;
• Follow-Up Treatment: Sets out any follow-up doctor visits or physical therapy necessitated by the injury and if injury was pre-existing, how the injury irritated this condition;
• Description of Injured Party: A short rundown about how the injury has changed the party’s life (absence from work, inability to perform household chores and economic hardships);
• Demand for Damages: A demand for damages including payment for lost wages, medical expenses and mental anguish;
• Signature: The claim form must be signed by the attorney or individual who suffered the slip and fall injury.

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This attorney-prepared packet contains:

1. General Information and Checklist
2. Claim Form – Slip and Fall (Commercial Property)

State Law Compliance: This form complies with the laws of all states