I am placing this request on the list-server at the
as a favor to a friend who does not have access to it. sec
_____________________________________________________________
Dear Law Libbers, 4/1/94
Our Public Services Department is considering implementing a formal greivance procedure
for our pro-se patrons. Please give the following proposed complaint form your critical attention.
Any suggestions or reactions would be appreciated.
Oliver W. Douglas III
Head of Public Services
Hadley V. Baxendale Law Library
Pithole, Pa.
_______________________________________________________________
HADLEY V. BAXENDALE LAW LIBRARY
PRO SE PATRON COMPLAINT FORM
LIBRARY FORM #8PRL-F001
In an effort to better serve the needs of the general public the administration of the Hadley V.
Baxendale Law Library has provided these forms for patrons to assess problems with the library's
public service procedures and policies. When problems arise please take a moment to fill out this
form, in triplicate, preferably using a ball-point pen, no.2 lead pencil, or red crayon. File copy #1,
(white), with the library administrative assistant, copy #2, (blue), with the Federal agency of your
choice, (eg. FBI), and keep copy #3, (yellow), for your personal files. Make legible marks to all
appropriate responses in the left side blank.
If you are unable to read these instructions a reference librarian will assist you by reading the
questions. However, library staff members are strictly prohibited from interpreting the questions on
this form.
Name
Address
(optional) age gender M F
Education: Grades 1 - 6 6 - 9 10 - 12
GED School of Beauty Culture
Correspondence School
Prison School of Hard Knocks
Other
What is your Occupation: Paralegal
Beauty Consultant Wilderness Guide
Body guard Mercenary
Historian Telemarketer
Bounty Hunter Library Student
Figure Skater U.S. Taxpayer
Satanic Cult Expert/Deprogrammer
Snap-on Tool rep Other
List all Correctional Facilities and time served:
County Jail
State Minimum Security
State Maximum Security
Federal Minimum Security
Federal Maximum Security
Institute for Violent Criminal Offenders
Other
What civic/professional organizations do you belong to:
Rotary Historical Society A.C.L.U.
S.L.A. (Special Libraries Association)
S.L.A. (Symbionese Liberation Army)
Posse Comitatus W.C.T.U.
A.A.L.L. (student member)
N.R.A. Other
How did you find our Library?
Lawyer's referral Judge's referral
Doctor's referral Cellmate's referral
Stumbled in Voice in my head
Librarian's referral (please let us know
who the librarian was, and where they work, so we
may personally thank them):
What is the nature of your research?
Pending civil trial
Pending criminal trial
Pending civil appeal
Pending criminal appeal
Pending capital offense appeal
Geneology Traffic violation
Constitutional Tax Issue
Federal Wiretapping Law
Divorce Parental Divorce, (please
indicate by child or parent)
JFK Assassination Conspiracy
UFO Operation Bluebook Coverup
Conspiracy of the Illuminati
Motion to remove government planted transmitter from my head
Library school assignment
Other (25 words or less)
Nature of Library Problem:
Library was: too hot too cold
too loud too quiet
too dark too bright too crowded
too full of strangers staring at me and listening to my thoughts.
just right for my purposes,
(please explain in 25 words or less)
Library staff was: uncooperative smug
surly stoopid prudish
insulting to: me
my spouse my mother
my hounddog Blue my pickup truck
THE FLAG/BIBLE
Library photocopiers were:
too hot too cold
too loud just right
uncooperative
stealing my life savings
destroying our natural resources
infringing on my moral rights as a performance artist
destroying our library school treasure hunt
Library was out of the following supplies:
copier paper copier toner
pens paper clips
aspirin AK-47 magazine clips
Kleenex other
The following was lost/stolen: pen
personal book(s) notes
tape recorder brief case
purse/wallet laptop computer
lunch historical manuscript
novel manuscript ideas/thoughts
generic brown-paper-wrapped-ticking
package (mark here if rush)
pet: cat mouse dog
spider snake
6ft. rabbit other pet
other items (please describe):
Librarian on duty was:
bearded, fat guy
tall, skinny guy with glasses
short lady with black hair in a bun
short lady with gray hair in a bun
short lady with white hair in a bun
night time desk attendant suffering from
porphyria
Action recommended: purchase new copiers
hire more staff
fire all staff
find that package
burn the place down and start all over
repent now, or burn for eternity!
Library Response: requested
not necessary
not necessary because I'm telepathic.
Thank you for having taken the time to fill out the law library's Pro Se Patron Complaint form.
We will keep this information strictly confidential, and use it only to assess
how well the library is fulfilling its mission of providing legal research services to the public.
LIBRARY FORM #8PRL-F001z.2U APPENDIX
________________________________________________________________
FOR OFFICE USE ONLY
Recommended disposition:
take patron recommended action
survey user group
file for future
discuss at admin. meeting
refer patron to another library
take medication
dispose of
call S.W.A.T. team
take April Fool's Day vacation! :-)sec
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