Garrity Rule

On __________________ (day/date), at ____________ hours, at ________________________ (location), I was ordered to submit this report by ____________________________ (name & rank). I submitted this report at his/her order as a condition of employment. In view of possible job forfeiture, I have no alternative but to abide by this order.

It is my belief and understanding that the department requires this report solely and exclusively for internal purposes and will not release it to any other agency. It is my further belief that this report will not and cannot be used against me in any subsequent proceedings other than disciplinary proceedings within the confines of the department itself. I authorize release of this report to my attorney or designated union representative.

For any and all other purposes, I hereby reserve my constitutional right to remain silent under the FIFTH and FOURTEENTH AMENDMENTS to the UNITED STATES CONSTITUTION  and any other rights prescribed by law. Further, I rely specifically upon the protection afforded me under the doctrines set forth in Garrity vs. New Jersey, 385 U.S. 493 (1967), and Spevack vs. Klein, 385 U.S. 551 (1956), should this report be used for any other purpose of whatsoever kind or description.