Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Complainant Worksheet

What is the Complainant Worksheet?

A fillable form in three parts that can be downloaded to help gather and organize information and documents needed to consult legal counsel and to file grievances, human rights complaints or civil suits.

Who should complete the worksheet?

Conscientious practitioners (including applicants and students) who suffer significant difficulty or disadvantage because they are unwilling to act contrary to their conscientious convictions/religious beliefs by providing or facilitating procedures or services.

What is included in the worksheet?
Part I: Overview
  • Confidentiality
  • Nature of complaint
  • Practitioner details
  • Parties involved
  • Executive Summary
    • 1. What happened?
    •  2. Who is responsible?
Download Part I: Overview

Part II: Details
  • Confidentiality
  • Nature of complaint
  • Details
    • 1. Application process for educational programmes or employment
    • 2. Notice re: accommodation/expectations in education/employment
    • 3. Demand by person in authority (employer, supervisor, instructor, etc.)
    • 4. If you acted contrary to your convictions
    • 5. If you refused to act contrary to your convictions
    • 6. If there was a complaint against you
    • 7. If you made a complaint
Download Part II: Details

Part III: Document Checklist
  • Confidentiality
  • Documents
    • In my possession
    • Elsewhere
Download Part III: Documents

If needed, fillable forms for Additional Parties Involved can be downloaded from the Project website.

Download Additional Parties


The worksheet is intended for your personal use. Should you decide to share it with the Protection of Conscience Project or others, the first section of the worksheet allows you to give directions to maintain confidentiality and privacy.