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Protection of Conscience Project

www.consciencelaws.org

Service, not Servitude
Resources

Victim Worksheet

Documents in My Control

I believe that the following documents indicate unjust discrimination for reasons of conscience, and I have them in my possession, or under my control at the location(s) indicated:

CONFIDENTIAL REPORT
DO NOT send to Project

(Make as many copies as required)
Complete and retain for counsel.

Letters Re: Employment

Letter(s) of support Letter(s) of dismissal Letter(s) of reprimand
  Letter(s) of complaint   Caution/warning letters    
         
Other (Specify):
Description of document(s):
Location(s) held:
 

Employer Policy

  Manual(s)   Bulletin(s)   Letter(s)
  Manual Extract(s)   Directive(s)   Newsletter(s)
  Memo(s)   Minutes    
       
Other (Specify):
Description of document(s):
Location(s) held:
 

Unions/Associations

Manual(s)   Bulletin(s)   Letter(s)
  Manual Extract(s)   Directive(s)   Newsletter(s)
  Memo(s)   Minutes    
       
Other (Specify):
Description of document(s):
Location(s) held:
 

Legal Documents

Transcript(s) Settlement(s) Court/Tribunal Order(s)
  Judgement(s)   Affidavit(s)    
         
Other (Specify):
Description of document(s):
Location(s) held:
 

Audio/visual/electronic materials

Videotape(s) CD(s) Floppy Disk(s)
  Audiotape(s)   DVD(s)   Photographs
         
Other (Specify):
Description of material(s):
Location(s) held:
 

Professional Publications

Manual(s)   Memo(s)   Letter(s) to Editor(s)
  Manual Extract(s)   Letter(s)   Opinion Column(s)
  Directive(s)    Newsletter(s)    
  Bulletin(s)   Editorial(s)    
       
Other (Specify):
Description of Document(s):
Journal Citations, Location(s) held:
 

Medical Reports

Personal health records Worker Compensation Records Insurance Records
         
Other (Specify):
Description of material(s):
Location(s) held:
 

Expenses

Bills Totals Locations held:
Legal expenses
Medical expenses
Travel expenses
Other expenses

 

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