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F334.97A/40+/zRG7 (Mass Termination (T#>40) Request Form)

This document enables the bearer to carry out only one mass termination



Service Group:

Happiness Rating: 1 2 3 4 5 6 7 8 9 0

(Please bite into the 'DENTAL RECORD' box in the upper right corner of this form)

Why do you need a mass termination form?

We need more detail.

What makes you think we're going to authorise this action?

Why has The Computer not already terminated these citizens?

What Service Group do you hold personally responsible for this situation?

Will this mass termination improve dental hygiene in Alpha Complex?

Do you think The Computer has chosen you personally to carry out this termination?

Were you in any way involved in the COL_gate_incident?

Were you in any way involved in the False_Teeth_Conspiracy?

Are you quite sure?

Do you wish you had been?

What does the inkblot on the reverse side of this form mean to you personally?


Explain how the expense of this termination is justified? Use diagrams.

How many citizens would you like to terminate?

Have the citizens in question been informed of their termination?

Is this termination going to be: (please tick as appropriate)

Will this action be the indirect cause of any of the following: (please tick as appropriate)


How much B3 have you consumed within the last 72 hours?

Did you consume the said B3 in the authorised manner?

Are you quite sure?

Have you experienced any of the following in the last weekcycle?

What is your favourite colour?

Please read and sign to accept the following statement:

I, the undersigned, accept full responsibility for any unauthorised disruption that may result from my actions.


Citizen Loyalty Rating:

Whacko Index:

Soylent Green Probability ratio:

Dental Hygiene Score:


Recommendation: Approve/Deny/Investigate/Ignore/File/Therapy/Termination/B3 Addicition/Other

-- Make-U-CRY-2

refs: COL_gate_incident; False_Teeth_Conspiracy; Compulsory_Consumer_Hour; Mutant_Plaque_Residuals.

It should be noted that a new revision of this form is due to be deployed shortly. It remains mostly unchanged, merely adding the option "Greasy" to II.4, and "Gout" to II.5. Don't ask.


I had some vulture troops chase away some commies who were apparently trying to alter this report by inserting some comment about "reel liv" or some other nonsense. I trust that everything is back to normal now.

-- Omega-U-MAN-5


2013-06-13 13:57