Activities Checklist - Crain/schuette Attorneys
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4Larry L. Crain (TN, VA, DC)
Brian Schuette (KY, TN)
C. David Keen (KY)
James C. Jones, (KY)
C. Michael Carey (KY)
Amanda Blakeman (KY)
Joshua D. Hershberger (KY, IN)
Ashlea Shepherd Porter (KY)
ACTIVITIES CHECKLIST
Please check any of the following that you once participated in and were unable to perform
or had difficulty performing during your recovery as a result of the accident.
If you are going to claim lost wages you need to provide us a statement from your
employed stating what you were making as well as the days you missed, and a doctor’s statement
excusing you of those absences:
JOB RELATED:
Give a brief description of your job duties, job title, and place of employment:
____________ Driving
____________ Sitting for long periods of time
____________ Standing for long periods of time
____________ Heavy lifting
____________ Reading, writing, computer work
____________ Precision work
____________ Other (Please list):
Describe reasons for any difficulties:
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Parent category: Life