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Protection of Conscience Project

Service, not Servitude

Victim Worksheet


What is the Victim Worksheet?

A document that helps conscientious objectors to gather and organize material needed to file grievances, human rights complaints or civil suits.

Who should complete the worksheet?

Anyone who, as a result of conscientious objection to medical procedures, has

  • experienced coercion
  • suffered discrimination or other adverse social, educational or employment consequences
  • had an application refused
  • experienced coercive questioning or interviews during an application process
  • experienced discriminatory or coercive educational practices
  • had to participate in medical procedures despite conscientious objection.

What does the Worksheet include?

A General Report, for recording details about the incident.

A Persons Report, for recording the particulars of persons involved.

A Documents Report, for listing documents relevant to the incident.


Information collected will be used only for the purpose of documenting problems faced by conscientious objectors and/or assisting the originator of the report.  Information will not be shared except in accordance with your directions.

A place is provided in Part I of the General Report where you can express concerns about making a complaint and give direction about the use of the information you provide.

How do I access the Worksheet?

Access the Victim Worksheet using the links in the sidebar.

How do I print the Worksheet?

The Victim Worksheet will print from the screen in print-friendly format.  Use "print preview" in your web browser to see what it looks like.  You can also download and print a .pdf version.

Instructions for completion of Worksheet

1.  Before completing the Worksheet, determine how many different incidents are involved.  Print/photocopy enough blank worksheets to document all of the incidents.

2.   Feel free to add or refer to other documents or additional information that you believe to be relevant.

What do I do with the completed Worksheet?

1.  Bring a copy of the completed Worksheet to a lawyer or other person qualified to assist you in filing a grievance, complaint or lawsuit.

2.  If you wish, you may send the General part of the Worksheet to the Protection of Conscience Project to help document the nature and scope of the problems faced by conscientious objectors.  In some cases, it may be possible to refer a complainant to legal counsel or other appropriate source of assistance or support.

  • Send ONLY the General part of the Worksheet marked "copy to Project." The General part of the Worksheet does not contain information about other people.

    The Protection of Conscience Project,
    7120 Tofino St., Powell River,
    British Columbia, Canada  V8A 1G3


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