I’ve pasted the torture questionnaire below. Please copy and paste this form into a Word document. Then fill it out and send it as an email attachment along with your other documents, pictures, and other evidence to Mr. Juan Mendez at:
Although it is important to provide as much detail as possible, the lack of a comprehensive accounting should not necessarily preclude the submission of reports.
Additional sheets should be attached where space does not allow for a full rendering of the information requested. Also, copies of any relevant corroborating documents, such as medical or police records should be supplied where it is believed that such information may contribute to a fuller accounting of the incident. Only copies and not originals of such documents should be sent.
I. Identity of the person(s) subjected to torture
A. Family Name
B. First and other names
C. Sex: Male Female
D. Birth date or age
G. Identity card number (if applicable)
F. Activities (trade union, political, religious, humanitarian/ solidarity, press, etc.)
G. Residential and/or work address
II. Circumstances surrounding torture
A. Date and place of arrest and subsequent torture
B. Identity of force(s) carrying out the initial detention and/or torture (police, intelligence services, armed forces, paramilitary, prison officials, other)
C. Were any person, such as a lawyer, relatives or friends, permitted to see the victim during detention? If so, how long after the arrest?
D. Describe the methods of torture used
E. What injuries were sustained as a result of the torture?
F. What was believed to be the purpose of the torture?
G. Was the victim examined by a doctor at any point during or after his/her ordeal? If so, when? Was the examination performed by a prison or government doctor?
H. Was appropriate treatment received for injuries sustained as a result of the torture?
I. Was the medical examination performed in a manner which would enable the doctor to detect evidence of injuries sustained as a result of the torture? Were any medical reports or certificates issued? If so, what did the reports reveal?
J. If the victim died in custody, was an autopsy or forensic examination performed and which were the results?
III. Remedial action
Were any domestic remedies pursued by the victim or his/her family or representatives (complaints with the forces responsible, the judiciary, political organs, etc.)? If so, what was the result?
IV. Information concerning the author of the present report:
A. Family Name
B. First Name
C. Relationship to victim
D. Organization represented, if any
E. Present full address