***THIS IS NOT INTENDED AS LEGAL ADVICE. You use this accepting the circumstances that may come from presenting this letter to your employer. Please consult a lawyer for legal advice***


Please use as you see fit. Edit it to make it your own with your details.


To:  [whoever is responsible for the mandate notice or your chief with address of HQ or where they work, along with their email address if you have it]




To whom it may concern,

I am writing in relation to the recent mandate re: mandatory COVID-19 vaccinations and mandatory testing of COVID-19 for unvaccinated, accommodated person(s) and those who chose not to disclose their private medical history to [insert employer].

I am not going to disclose my vaccination status to the [insert employer] as my medical health is protected by privacy laws. My medical health and choices are private and confidential and I am not required to disclose these to anyone. The [insert employer] does not have the right to ask me about my vaccination status. My privacy is protected under the Personal Information Protection and Electronic Documents Act, 2000 (PIPEDA) as well as the Personal Health Information Protection Act, 2004 (PHIPA) as well as the Ontario Occupational Health and Safety Act, R.S.O. 1990, c. O.1 and the Municipal Freedom of Information and Protection of Privacy Act, RSO 1990.

I am not going to consent to any type of COVID-19 testing that the [insert employer] is mandating. I do not give my informed consent.

Informed consent means that the person who will administer the medical treatment or procedure, needs to inform you of all the benefits and risks associated with the medical treatment or procedures as well as alternative treatments before you decide if you will consent or not. This is medical freedom. These are our God-given inalienable rights.

Elements of consent: your expressed, informed and explicit consent (voluntary) must be obtained prior to treatment. Without consent it is considered assault under the Criminal Code of Canada. Consent given under fear or duress is not consent. Section 265(3) of the Criminal Code of Canada defines consent in relation to assault as:


(3) For the purposes of this section, no consent is obtained where the complainant submits or does not resist by reason of

  • (a)the application of force to the complainant or to a person other than the complainant;
  • (b)threats or fear of the application of force to the complainant or to a person other than the complainant;
  • (c)fraud; or
  • (d)the exercise of authority.


The Ontario Health Care Consent Act, 1996 defines “consent” as well :

Consent to Treatment

No treatment without consent

10 (1) A health practitioner who proposes a treatment for a person shall not administer the treatment, and shall take reasonable steps to ensure that it is not administered, unless,

(a)  he or she is of the opinion that the person is capable with respect to the treatment, and the person has given consent; or

(b)  he or she is of the opinion that the person is incapable with respect to the treatment, and the person’s substitute decision-maker has given consent on the person’s behalf in accordance with this Act.  1996, c. 2, Sched. A, s. 10 (1).

Elements of consent

11 (1) The following are the elements required for consent to treatment:

  1. The consent must relate to the treatment.
  2. The consent must be informed.
  3. The consent must be given voluntarily.
  4. The consent must not be obtained through misrepresentation or fraud.  1996, c. 2, Sched. A, s. 11 (1).

Treatment is defined in the Ontario Health Care Consent Act, 1996 as follows:

“means anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose, and includes a course of treatment, plan of treatment or community treatment plan”. This definition would include any vaccination or any COVID-19 test, as they are both, allegedly, “preventive”, “diagnostic” and for a “health-related purpose”.

The Nuremberg Code, to which Canada is a signatory, states that it is essential before performing a medical procedure on human beings, that there is voluntary informed consent. It also confirms a person involved should have legal capacity to give consent, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him/her to make an informed decision.


Nuremberg Code: Article 6, Section 1:

Any preventative, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be expressed and may be withdrawn by the person concerned at any time and for any reason without disadvantage or prejudice.

Nuremberg Code: Article 6: Section 3:

In no case should a collective community agreement or the consent of a community leader or other authority substitute for an individual’s informed consent.

By forcing employees to submit to a COVID-19 vaccination or test (including the rapid antigen test), you are in breach of the Nuremberg Code.

Furthermore, the Supreme Court of Canada has well established case law that deals with medical treatment without the informed consent of the patient. Case law, to some in the legal field, would be regarded as the most recent, gold-standard-type of law. Case law cannot be overturned or overruled without new case law on that issue. The Supreme Court of Canada has made it clear that it is unconstitutional to force medical treatment of any kind without the informed consent of the patient. Any action taken by an employer in contravention of case law, would be unlawful.

In terms of accessing my health records, the Ontario Occupational Health and Safety Act also speaks to this. Under the Ontario Occupational Health and Safety Act, R.S.O. 1990, c. O.1 under Section 63(2) it states:

Information confidential

Employer access to health records

(2) No employer shall seek to gain access, except by an order of the court or other tribunal or in order to comply with another statute, to a health record concerning a worker without the worker’s written consent.  R.S.O. 1990, c. O.1, s. 63 (2).

Also under the Ontario Occupational Health and Safety Act, R.S.O. 1990, c O.1 it outlines penalties:



66 (1) Every person who contravenes or fails to comply with,

(a) a provision of this Act or the regulations;

(b) an order or requirement of an inspector or a Director; or

(c) an order of the Minister,

is guilty of an offence and on conviction is liable to a fine of not more than $100,000 or to imprisonment for a term of not more than twelve months, or to both.  R.S.O. 1990, c. O.1, s. 66 (1); 2017, c. 34, Sched. 30, s. 4 (1).

While I recognize that Section 63(2) of the Ontario Occupational Health and Safety Act, 1990, states that accessing the health records of an employee is subject to any other statue (which presumably includes the Reopening Ontario {A Flexible Response to Covid-19} Act, 2020), it is nonetheless important to highlight this Act. “Any other statue” is a very broad legal inclusion and would include many of the laws I have referenced in this letter.

Furthermore, the Canadian Charter of Rights and Freedoms Section 2 (a) (freedom of conscience and religion) and Section 7 (everyone has the right to life, liberty, and security of person and the right not to be deprived thereof except in accordance with the principles of fundamental justice), apply to these mandates. Human bodily autonomy is as basic as it gets in terms of rights. I have the right to liberty – and this includes my right to refuse medical treatment (including vaccines or any of the available tests for COVID-19).

The PCR test is a form of genetic test and also would fall under the definition of a medical procedure. The following legislation also applies: Bill S-201, Statues of Canada 2017: “An Act to prohibit and prevent genetic discrimination”. In it, it clearly defines “genetic test”: genetic test means a test that analyzes DNA, RNA or chromosomes for purposes such as the prediction of disease or vertical transmission risks, or monitoring, diagnosis or prognosis. (test génétique)

Furthermore, in this legislation it also outlines Prohibitions:


Genetic test

3 (1) It is prohibited for any person to require an individual to undergo a genetic test as a condition of

(a) providing goods or services to that individual;

(b) entering into or continuing a contract or agreement with that individual; or

(c) offering or continuing specific terms or conditions in a contract or agreement with that individual.


This legislation also outlines “Offences and Punishment”

Contravention of sections 3 to 5

7 Every person who contravenes any of sections 3 to 5 is guilty of an offence and is liable

(a) on conviction on indictment, to a fine not exceeding $1,000,000 or to imprisonment for a term not exceeding five years, or to both; or

(b) on summary conviction, to a fine not exceeding $300,000 or to imprisonment for a term not exceeding twelve months, or to both.


Lastly, as indicated by Ontario Public Health numerous times (and as evidenced in our ICU statistics), vaccinated persons can still get and transmit COVID-19 despite their inoculation. With this “scientific” evidence, why are only the non-disclosed, unvaccinated or accommodated persons under the Human Rights Code, forced to comply with the mandatory COVID-19 testing? The testing, hypothetically, is to ensure that you don’t transmit COVID-19 to other co-workers or the citizens of [insert town/city] that you interact with on a regular basis. The fact that you are outwardly targeting unvaccinated, accommodated or non-disclosed employees is grounds for discrimination and harassment and is liable for legal action as well. In addition, by discriminating against non-disclosed, unvaccinated or accommodated employees, the [insert employer name but only if you have rules or procedures related to discrimination and/or harassment if NOT DELETE] its own [Procedure or whatever your work calls it].


It is evident that the [insert employer] is in breach of various federal and provincial legislations, as well as case law and their own internal procedures with the recent COVID-19 vaccination and testing mandates.

In conclusion, I hereby notify you that I will hold you personally liable for any financial injury and/or loss of my personal income and my ability to provide food and shelter for my family if you use coercion or discrimination against me based on my decision to not participate in [insert employer]’s COVID-19 vaccination and testing mandates nor will I disclose my vaccination status to you.


Name:                           ___________________________________


Signature:                      __________________________________


Date:                              ___________________________________


Witness Name:              ___________________________________


Witness Signature:        ___________________________________


Here is another letter with lots of links to further your case – download word doc here


For more information on Mandates click here