This form is designed as a general form for use with respect to all claims. Some of the questions may not be applicable to your particular claim.Act, this Tort Claims Act Questionnaire has been adopted as the official form for the filing of claims against the Township of Franklin. Under the FTCA, the federal government acts as a self-insurer, and recognizes liability for the negligent or wrongful acts or omissions of its employees. This Franklin County Claim for Damages Form (claim form) is provided pursuant to. No Franklin County employee is authorized to advise a claimant in completing this claim form or reviewing its sufficiency. In the alternative, defendants specially pleaded the doctrine of contributory negligence based on the same acts or omissions of plaintiff. Law holding Atain liable for the full amount of the tort judgment. In other words, the mere violation of a statute or ordinance would be definitive proof of negligence. Example. JBS S.A. illustrates how these negligence elements may apply in a.