Free printable first-call and attorney-review worksheet

Wrongful Death Intake Form for Law Firms: First-Call Questions & Review Workflow

Use this staged wrongful death intake form to guide a compassionate first call, preserve a conflict-safe incident snapshot, track family and representative details as reported, inventory record sources, and prepare a prompt attorney-review handoff without deciding standing, authority, causation, fault, deadlines, value, acceptance, or representation.

Jump to printable worksheet See the ClaimVela workflow

Published by ClaimVela · Updated October 20, 2026 · This operational resource is not legal, medical, probate, tax, financial, grief, or other professional advice, and it is not a universal form. Have authorized counsel adapt every question, notice, consent, conflict control, privacy safeguard, escalation rule, and communication step to the firm's jurisdictions and procedures.

Direct answer

A useful wrongful death intake form begins with a brief, compassionate first-call record: the caller and decedent, their reported relationship, when and where the death and underlying incident occurred, a neutral summary, known people and organizations, current or prior counsel, existing agency reports, and the exact wording of any urgent document. Deeper family, representative, estate, medical, employment, benefit, insurance, and incident records belong after the firm's conflict and authorization gate.

Lead with care. Ask whether it is safe to speak, explain why limited questions matter, allow a pause, and avoid making the caller repeat the account unnecessarily.

Record; do not decide. Treat family, representative, estate, incident, and record details as reported until authorized review.

Assign the handoff. End with a named reviewer, a specific next action, a due time, and an approved path for the next contact.

Stage 0 · Compassionate and safe contact

Create room for the caller before collecting facts

Use the caller's name, acknowledge the death without assuming the caller's relationship or experience, and ask whether it is safe and manageable to continue. Explain that the first call is brief and does not decide whether the firm can help. Offer to pause, repeat, use an interpreter, or arrange an approved return contact. If the caller reports immediate danger or a medical emergency, use the firm's reviewed emergency procedure before routine intake.

Ask permission

Tell the caller what the opening questions cover, why the firm needs them, and that unknown answers are acceptable. Ask the caller to answer only the questions posed and not to volunteer or send unrelated sensitive details or records before the firm requests them through an approved process.

Reduce repetition

Preserve the caller's words and pass the first account forward so the caller is not asked to retell it without an operational reason.

Set a realistic next step

Give only the firm-approved response path and timing. Do not promise acceptance, representation, recovery, or a result.

Stage 1 · Before conflict clearance

Preserve a limited wrongful death inquiry snapshot

Collect only the information reasonably needed to identify the prospective matter, run the firm's duplicate and conflict process, route urgent wording, and assign review. Do not request full Social Security numbers, credentials, broad medical files, unnecessary dates of birth, or unnecessary details about minors during first contact.

Caller and safe contact

Open with empathy, confirm that it is safe to continue, and create a permitted path for the firm to respond.

Inquiry ID, received date and time, source, channel, referral, and campaign
Caller name, preferred name, phone, email, preferred method, safe contact times, and message restrictions
Whether the caller can speak now, wants a pause, needs an interpreter or accessibility support, or prefers another authorized contact
Inquiry-contact permission and the notice version, timestamp, and recorded action
Optional marketing consent kept separate from required inquiry contact
Preferred language, local time zone, assigned owner, and response target

Caller, decedent, and reported relationship

Collect enough identity and relationship information for duplicate and conflict review without deciding legal eligibility or authority.

Decedent's full name, known name variations, and city or state of residence
Caller-reported relationship to the decedent, stated in the caller's own words
Names of only those additional people the firm requires for its initial duplicate and conflict review
Any representative, estate contact, guardian, probate attorney, or other authority-related identity already volunteered and reasonably needed for opening controls, labeled as reported
Only limited identifiers reasonably needed for the firm's opening review; no full Social Security numbers or unnecessary minor identifiers

Death and incident snapshot

Preserve a neutral first account without deciding cause, fault, standing, damages, or which law applies.

Date and place of death, if known, with estimated or unknown details labeled
Incident date, approximate time, location, city, county, state, and other possible jurisdiction information
Short neutral summary in the caller's own words, including what reportedly happened before and after
Reported setting: roadway, workplace, property, healthcare, product, animal, public space, custody, or another context
Whether the death occurred at the scene, during transport, at a facility, or later, only as reported

People and organizations

Capture only the central conflict names and reported roles the firm's opening process requires, without assigning legal responsibility.

People and organizations the caller identifies as directly involved in the underlying event, limited to what the firm reasonably needs for duplicate and conflict review
An employer, property owner, healthcare provider or facility, manufacturer, contractor, or government body only when its identity is central to opening controls
Legal names, trade names, locations, role descriptions, and name variations
The identified source for each name and relationship: caller, document, report, or another person
Unknown people or organizations described without guessing their identity

Counsel, agencies, and known reports

Identify current relationships and records that may change the firm's routing or conflict process.

Current or prior counsel for the caller, estate, family, decedent, or a related matter
Whether another engagement or consultation about the same matter is reportedly underway
The name of an agency or court and an existing report, case, or file number only when already volunteered and needed for routing
Exact wording from an already-received communication only when it may require prompt internal review
Broader agency, report, insurer, employer, facility, benefits, and custodian details deferred until the approved gate

Urgent wording and next action

Preserve exact external wording and assign prompt attorney review without calculating a deadline or directing outside contact.

Exact date and wording shown on any court, probate, agency, insurer, employer, facility, government, or other document
Whether a burial, cremation, autopsy, release, property change, device change, vehicle action, or other time-sensitive event is reportedly pending
Documents, records, media, devices, property, or other sources the caller already has or says exist
Current or expected communications, appointments, proceedings, or decisions already scheduled
Next internal action, authorized reviewer, priority, due date and time, time zone, and approved communication channel

Firm-defined prompt review

Route sensitive signals; do not make legal conclusions

Train intake staff on the firm's authorized response before these facts appear. A signal should change routing, access, or priority—not decide standing, representative authority, conflicts, causation, fault, deadlines, notice, value, acceptance, or representation.

The caller is in immediate danger, reports a medical emergency, or cannot safely continue

Pause ordinary intake and use the firm's approved emergency or safe-contact procedure. Record only what is needed to route the concern; do not diagnose or investigate.

A court, probate, government, agency, insurer, employer, facility, or other document states a response date

Preserve the exact wording and stated date, then route the document promptly to an authorized attorney. Do not calculate a deadline or notice period.

A burial, cremation, autopsy, release, inspection, vehicle action, device change, property change, or other event may affect a possible source

Record what reportedly exists, its location and custodian, and the upcoming event, then escalate under firm policy. Do not issue, recommend, or promise a preservation demand.

A minor, dependent adult, disputed family relationship, disputed representative, unopened estate, or unclear authority appears

Record each reported relationship and source separately, then request attorney review. Intake staff do not decide standing, beneficiary status, estate authority, or who may act.

The underlying event may involve a government body, workplace, healthcare provider, product, commercial vehicle, out-of-state party, or unfamiliar jurisdiction

Capture the known names, location, context, and existing documents, then route the matter. Do not decide which law, claim, notice rule, or liability theory applies.

The caller, estate, family, or related party has current or prior counsel or may have signed an agreement

Record the person's words and available documents, then request authorized review. Do not advise anyone to end another professional relationship.

A duplicate, related inquiry, family disagreement, adverse party, witness, organization, or other possible conflict input appears

Pause ordinary qualification, limit access under firm policy, and use the firm's conflict process. Intake staff do not clear conflicts.

Conflict and authorization gate

Pause before detailed family, estate, medical, or financial data

After the limited opening record, use the firm's conflict process and have an authorized reviewer decide what additional information is reasonably necessary, who may provide it, how it should be collected, and who may access it. The gate does not itself clear a conflict, establish authority, accept a matter, create representation, or determine that any person may act for the estate or another family member.

1. Check and limit

Run duplicate and conflict procedures, restrict access, and preserve the first account and exact document wording.

2. Authorize the scope

A reviewer chooses the next questions, documents, collection path, and internal recipients under firm policy.

3. Communicate status

Use approved language that accurately states the inquiry status and does not imply engagement or acceptance.

Stage 2 · Gated follow-up

Build a source-aware family, representative, and incident record

Ask these deeper questions only after the approved gate. Record family relationships, representative or estate status, cause or manner of death, agency findings, insurance activity, and every underlying-incident detail as reported unless the firm has reviewed a supporting record through an approved process.

Family and relationship map

Names and caller-reported relationships of a spouse, partner, children, parents, siblings, dependents, household members, or other possible family contacts
Whether any person is a minor or may need an authorized representative, recorded without unnecessary birth dates, school details, or other minor identifiers
Reported financial, caregiving, household, or other relationship information only when an authorized reviewer determines it is reasonably necessary
Different accounts of a relationship preserved separately with the source for each account
Confirmed, reported, disputed, unknown, and not-yet-obtained details kept distinct

Representative and estate status

Whether an estate is reportedly open, where, and any court or file identifier already shown on an existing document
Reported personal representative, executor, administrator, petitioner, nominated person, probate counsel, guardian, or other contact
Letters, orders, petitions, wills, trusts, powers, or other authority-related records reportedly existing, with custodian and status
Exact wording from available documents rather than intake conclusions about authority or legal effect
Questions about estate authority, standing, beneficiaries, conflicts, or capacity assigned to authorized counsel

Death, coroner, and agency records

Death certificate, coroner or medical examiner record, autopsy report, toxicology record, release record, police report, crash report, incident report, 911 record, or regulator record reportedly existing
Issuing organization, report or file number, event date, current status, source, and reported custodian
Cause or manner of death only as stated in an identified record or by an identified source; do not infer causation
Which record has been reviewed, requested through an approved process, disputed, unavailable, or not yet obtained
Any exact agency or court wording requiring prompt attorney review

Medical, funeral, work, benefit, and insurance sources

After the approved gate: treating facilities and clinicians, transport, billing, pharmacy, funeral, burial, cremation, and related record sources
Employer, payroll, tax, pension, union, leave, disability, life-insurance, health-insurance, government-benefit, or other benefit sources only when reasonably necessary
Known insurer, policyholder, claim number, adjuster, statement, authorization, release, payment, offer, denial, reservation, letter, email, or message
Reported expenses or financial effects tied to an identified record or source without estimating damages or value
Sensitive records and authorizations collected only through the firm's approved secure process

Underlying-incident branch

For a roadway event: people, vehicles, owners, employers, roadway location, reports, tow or storage status, and camera or vehicle-data sources
For a property or animal event: location, owner or operator, condition or animal identifiers, responders, reports, and media sources
For healthcare: facilities, providers, dates, procedures, records, communications, and reported sequence—without forming a medical or causation conclusion
For a workplace, product, government, custody, or other event: the organizations, item identifiers, location, records, and reported roles
Facts common to more than one branch preserved once, with conflicting versions and unknowns clearly labeled

Attorney-review handoff

A concise chronology that separates direct observation, caller report, document content, another person's statement, and unknown information
People, organizations, jurisdictions, family or estate questions, counsel relationships, and conflict inputs requiring review
Record and evidence-source register with identifiers, custodians, locations, statuses, access, and reported change or loss risk
Exact document wording and stated dates copied without calculating a legal deadline
Review owner, priority, next action, due time, approved contact route, and disposition-delivery result

Copyable printable template

Wrongful Death Intake Form — Operational Worksheet

Print this worksheet or translate its sections into the firm's reviewed intake system. Complete detailed or sensitive sections only after the conflict and authorization gate. This form records reported people, relationships, records, and sources; it does not direct the caller to contact family members, adverse parties, agencies, witnesses, insurers, employers, providers, or record custodians.

A. Intake control — internal

Inquiry ID:

Received date, time, and time zone:

Source, channel, campaign, or referral:

Assigned owner and response target:

Duplicate and conflict-review status:

Prompt-review action and escalation result:

Acknowledgement delivery result:

Notice and consent version, timestamp, and recorded action:

B. Caller and safe contact

Caller name and preferred name:

Phone and email:

Reported relationship to the decedent:

Approved contact method, times, and message restrictions:

Whether it is safe to continue now:

Alternate authorized contact, if any:

Preferred language and accessibility needs:

Inquiry-contact permission by channel:

C. Decedent and first snapshot

Decedent name and known name variations:

City and state of residence:

Date and place of death, if known:

Incident date and approximate time:

Incident place, city, county, state, and possible jurisdiction:

Neutral first account in the caller's words:

Reported setting or incident category:

Source and accuracy label for each detail:

D. Limited opening identities — pre-gate

Caller and decedent names and name variations:

Caller-reported relationship:

Additional identity required by the firm's duplicate or conflict process:

People directly involved in the event, only as needed for opening controls:

Central employer, owner, operator, facility, provider, company, or government identity, if required:

Current or prior counsel for the same or a related matter:

Name variations and trade names:

Source for each reported role or relationship:

E. Limited routing and urgent wording — pre-gate

Current or prior counsel and reported scope:

Agency or court identity already volunteered and needed for routing:

Existing report, case, or file number already available:

Exact wording and stated date from any urgent document:

Pending proceeding, appointment, release, burial, cremation, or other event:

Document or media already held by the caller:

Broader family, estate, medical, employment, benefits, insurance, agency, and custodian details deferred until the gate:

Internal review owner and time:

Approved next action and delivery result:

F. Gated family and representative follow-up

Reported family or dependent relationship map:

Disputed or unknown relationships and their sources:

Estate-open status and court, if reported:

Reported personal representative, executor, administrator, petitioner, or other contact:

Existing authority-related document and exact title:

Document custodian, location, access, and status:

Attorney-review question:

Accuracy label: confirmed, reported, disputed, unknown, or not yet obtained:

G. Gated record-source inventory

Death certificate source:

Coroner, medical examiner, autopsy, or toxicology source:

Police, crash, incident, 911, regulator, or agency source:

Medical, transport, billing, or pharmacy source:

Funeral, burial, cremation, or related source:

Employment, wage, tax, pension, union, or benefit source:

Insurance, claim, communication, or payment source:

Identifier, custodian, date, status, and internal owner for each source:

H. Underlying incident and final handoff

Applicable incident branch and neutral chronology:

People, organizations, items, locations, and reported roles:

Existing reports, photos, video, devices, property, vehicles, or other sources:

Reported custodian, location, access, status, and change or loss risk:

Open factual gaps and conflicting versions:

Questions reserved for attorney review:

Review owner, priority, due date and time:

Disposition, engagement status, and approved communication result:

Printable companion registers

Family, Entity & Evidence-Source Register

Accuracy labels

Keep reports, records, and conclusions distinct

Confirmed

Supported by a record the firm has reviewed or directly verified through an approved process.

Reported

Provided by the caller or another identified source but not independently verified.

Disputed

Accounts, relationships, identifiers, or records differ; preserve each version and source without resolving the issue in intake.

Unknown

The person does not know or the information is unavailable; never replace it with an assumption.

Not yet obtained

A specific record or answer is identified but has not been received through an approved process; assign an internal owner and status.

Intake guardrails

Preserve facts without deciding the case

Do not decide wrongful-death eligibility, standing, beneficiary status, survivor status, estate authority, capacity, conflicts, or who may act for another person.
Do not decide cause or manner of death, medical or legal causation, fault, negligence, agency, product defect, notice, responsibility, or which law applies.
Do not calculate filing, notice, probate, government, insurance, preservation, records-retention, or other deadlines or windows.
Do not estimate damages, economic loss, support, benefits, insurance coverage, settlement range, case value, acceptance likelihood, or outcome.
Do not request full Social Security numbers, account credentials, unnecessary full dates of birth, broad medical files, or unnecessary identifiers for minors during first contact.
Do not direct anyone to contact or confront a potentially adverse party, agency, witness, insurer, employer, facility, provider, custodian, family member, or other outside person.
Do not direct anyone to demand records, issue a preservation request, enter property, retrieve a vehicle or device, inspect, move, repair, alter, release, post, transfer, or destroy an item.
Do not advise what to say, sign, submit, accept, reject, authorize, post, or disclose to an insurer, agency, employer, provider, court, family member, or other person.
Do not state or imply that submission creates representation, clears conflicts, accepts the matter, guarantees confidentiality, or promises a legal result.
Use compassionate language without promising an answer, outcome, timeline, or attorney-client relationship. Engagement requires the firm's authorized process.

Compassionate first contact

Consistency can still leave room for the person

A structured call does not require rushed or clinical language. Explain each short section, accept unknowns, preserve the caller's words, allow a pause, and avoid asking the person to retell distressing details merely because the workflow changed hands.

Relationship and authority

Capture the source; reserve the conclusion

A caller's relationship, an estate filing, a will, a court document, or another person's statement can be recorded with its source. Intake staff should not decide who may bring a claim, represent an estate, authorize a request, or receive information.

Cause and underlying incident

Branch the questions without forming a theory

Use the roadway, property, animal, healthcare, workplace, product, government, custody, or other branch to identify people, organizations, records, and sources. Do not convert the branch into a conclusion about cause, fault, law, liability, or recoverable damages.

Official sources for workflow design

Adapt the form through authorized review

Prospective-client information boundaries

The ABA Model Rule 1.18 commentary discusses limiting an initial consultation to information reasonably necessary for the representation decision. It is model guidance; the jurisdiction's adopted rules and law control.

Limit unrequested prospective-client details

ABA Formal Opinion 510 discusses reasonable measures to limit information received from a prospective client, including clear instructions not to provide more information than requested before the lawyer determines whether to proceed. It is ethics guidance, not binding law; the jurisdiction's adopted rules and law control.

Supervised intake and legal judgment

ABA Formal Opinion 506 discusses supervised nonlawyer intake and the need to reserve legal judgment for lawyers. The opinion is guidance, not a substitute for local ethics and unauthorized-practice rules.

Confidentiality safeguards

ABA Model Rule 1.6 addresses safeguards for client information. For prospective-client information, Rule 1.18 and the applicable local rules also matter. These ABA model rules are guidance; the governing jurisdiction's rules control.

Data minimization and access

The FTC's Start with Security recommends collecting only needed data, retaining it only for a legitimate need, and limiting access. It supports a staged form and role-based handling, not a security, privacy, or compliance safe harbor.

These official sources support limited first contact, supervised intake, confidentiality safeguards, and data minimization. They do not supply wrongful-death eligibility, standing, estate authority, causation, liability, damages, deadlines, notice, conflict clearance, or case-acceptance rules for a particular matter. Local law, rules, and authorized attorney judgment control.

Frequently asked questions

Building a careful wrongful death intake form

What should a wrongful death intake form collect first?

Start with safe contact information, the people and organizations needed for opening controls, the date and location of the reported death and underlying incident, a short neutral account in the caller's own words, the caller's reported relationship to the person who died, and an assigned next action. Sensitive records, financial details, and broader family or estate information should wait until the firm's approved conflict process and an authorized reviewer determine what is reasonably necessary.

How should intake record family and representative information after a reported death?

Record each person's name, contact role, reported relationship, and the source of that information without deciding who may act for an estate, who may bring a claim, or who may recover. Authority and eligibility depend on jurisdiction-specific law and documents, so intake should route those questions to authorized attorney review.

What incident facts belong in a wrongful death intake worksheet?

Capture a neutral first-person account, the date, time and location, known people and organizations, reported emergency or agency response, the type of incident, and possible report or evidence sources. Keep confirmed facts, reported details, disputed information, unknowns, and records not yet obtained visibly separate rather than turning the intake record into a fault or causation conclusion.

What possible records should a wrongful death intake form identify?

Depending on the reported facts, possible sources may include incident and agency reports, emergency-response records, death certificates, medical-examiner or coroner records, treatment records, photographs or video, witness details, employment or benefit records, insurance information, and estate or authority documents. Intake should identify what may exist, its possible custodian, and its status; authorized reviewers should decide what the firm may request or collect.

Should staff decide who can file a wrongful death claim during first intake?

No. Staff should not decide standing, beneficiary status, representative authority, deadlines, fault, damages, claim value, or whether a matter qualifies. Those questions require jurisdiction-specific legal judgment and should be routed to an authorized attorney with the source-labeled facts and documents needed for review.

Does submitting a wrongful death intake form create an attorney-client relationship?

A form should not promise or imply representation. Use firm-approved, jurisdiction-appropriate notices and keep the matter labeled as prospective-client work until the firm's authorized engagement requirements are complete.

Turn the worksheet into accountable intake

Keep first-call, family, representative, record-source, review, and handoff details in one workflow.

ClaimVela helps PI firms receive inquiries, assign ownership, collect structured facts and documents, prepare attorney review, collaborate securely, and hand retained matters forward without rebuilding the record. Attorneys remain responsible for conflicts, confidentiality, legal judgment, deadlines, qualification, engagement, and every representation decision.

Start 14-day trial Explore the real workflow