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Nail Gun (injuries)

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Complaint:

Nail Gun (injuries)

*Describe your complaint:
(briefly describe the damages you have suffered)

What is the date of the accident?

Can you estimate for us when the nail gun was purchased?

Did the nail gun work off an air compressor?

Yes No

What happened during the accident? [Did the nail gun

Did you come into contact with the spring-loaded safety at the end of the muzzle? If so, how?

Describe the injuries sustained, and particularly any problems that you continue to have as a result of the accident.

Do you know the brand of the nail gun involved?

What type of nail gun was involved: Trim nailer? Brad nailer? Framing nailer? Roofing nailer?

Do you have possession of the nail gun, or can you get possession of the nail gun?

Yes No

If you missed time from work, how much time? Have you returned to work or do you know when approximately you can expect to return?

*First name:

*Last name:

*Email address:

*Confirm email address:

*Phone number(s):

*Zip/Postal Code:

Best time & way to contact you:

I would like to be interviewed by a journalist.

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