Juror Questionnaire – Carbon County Utah

Dear Prospective Juror:
You have been chosen by random selection for jury service. Trial by jury is a fundamentally important part of our system of justice. It is both an opportunity and an obligation of every American to serve on a jury when selected.

This form is used to obtain information about you to determine if you are qualified to serve as a juror. It also helps the attorneys and parties select the jury for their case.

If you are unable to complete this form, someone else may do it for you. That person must indicate the reason for completing the form instead of you.

By completing this form and submitting it, you affirm that the answers are true, correct, and complete to the best of your knowledge.

You are instructed that you should not attempt to research this case or to try to learn about the case from sources outside the courtroom.

Email(Required)

Section 1

1. Full Name(Required)

2: Juror Number (This can be found in the email with the summons)(Required)

3. To qualify as a potential juror you must be 1) 18 years of age or older 2) a citizen of the United States 3) a resident of Carbon County 4) able to read, speak and understand English and 5) without a felony conviction on your record. Based on these standards, are you qualified to serve as a potential juror?(Required)

Yes

No, I am not qualified to serve as a potential juror.

If you answered NO to the above question, please indicate why you are not qualified to serve as a potential juror.(Required)

4. Age(Required)

5. Gender(Required)

6. If someone else helped you fill out this form, please write that person’s name below and explain the reason they helped you. If this does not apply, please go to the next question.

6(continued) Reason that you need assistance:(Required)

The responses given in this document are declared by you to be true and correct under criminal penalty according to the laws of Utah.

Based on your answers, your jury service may be deferred (postponed). Jurors who are deferred will receive a new summons for later service. Any questions should be directed to the Jury Clerk.

Section 2: (Case-specific Information)

1. Have you or a family member been the victim of a crime? *(Required)

Yes

2. Have any of your family members ever been arrested or convicted of a crime?(Required)

Yes

3. Have you or any member of your family ever worked for a law enforcement agency?(Required)

Yes

4. Would you give more or less credibility or weight to the testimony of a police officer than you would to any other witness simply because the witness is a police officer? *(Required)

Yes

5. Have you had any prior experience on a jury?(Required)

Yes

6. If so, was it civil or criminal?(Required)

Civil

Criminal

7. Did you reach a verdict?(Required)

Yes

8. Do you feel that you, a member of your family, or someone close to you has been treated unfairly by the police or prosecution authorities?(Required)

Yes

9. It is the duty of the judge, not the jury, to determine punishment in the event the defendant is found guilty of the charge. Are you able disregard the issue of punishment and base your decision of guilt or innocence solely on the facts presented in court?(Required)

Yes

10. Are you willing to follow the law as the judge instructs you, regardless of what you think the law is or ought to be?(Required)

Yes

Section 3

1. Where do you live (City, State)?(Required)

2. How long have you lived there(Required)

3. What is your occupation? If you are retired, what did you do for a living?(Required)

4. Are you married or do you have a significant other? What is his/her occupation?(Required)

5. Do you have children? If so, how many and what are their ages?(Required)

6. What is the extent of your education and area of focus if any?(Required)

7. What publications do you subscribe to or read regularly? Where do you get your news?(Required)

8. What types of television programs do you regularly watch?(Required)

9. What internet sites or social media apps do you regularly use?(Required)

10. What are your hobbies or leisure activities?(Required)

Section 4

The safety of jurors and court employees remains the Court’s highest priority. As the COVID-19 outbreak continues to evolve, the Court is following current recommendations from the Centers for Disease Control (CDC) and local and national health authorities.

To prevent the spread of COVID-19 and reduce the potential risk of exposure to jurors and our staff, we are conducting a simple screening questionnaire. Your participation is important to help us take precautionary measures to protect you and everyone in our courthouses.

1. Are you over age 60, or a person of any age with an underlying medical condition that puts you at a higher risk of developing serious health complications from COVID-19?(Required)

Yes

2. Do you live with or provide direct care for a person vulnerable to COVID-19?(Required)

Yes

3. Do you live with or provide direct care for a person vulnerable to COVID-19?(Required)

Yes

4. Do you have children at home who require your direct supervision due to school and/or daycare closings? Note: Only answer YES if there is no one else in the household who can provide care during your jury service.(Required)

Yes

5. If you answered "Yes" to any of the questions in this section (Section 2: COVID-19 Risk Factors), are you willing to serve as juror in this case?(Required)

Yes

By typing your name below and submitting this form you are declaring under criminal penalty that the statements in this form are true and correct. (Type your name below)

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Section 1

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Section 4

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