Crime-Victim and Witness Court-Attendance Leave Request Packet
CRIME-VICTIM, FAMILY-VIOLENCE, OR CRIMINAL-WITNESS ATTENDANCE REQUEST PACKET
Connecticut — Conn. Gen. Stat. § 54-85b
1. EMPLOYEE AND EMPLOYER
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| Employer | [________________________________] |
| Position / department | [________________________________] |
| HR / supervisor contact | [________________________________] |
| Preferred confidential contact | [________________________________] |
2. SELECT ONE ATTENDANCE ROUTE
Route A — subpoenaed criminal witness
- ☐ Employee is obeying a legal subpoena to appear before a Connecticut court.
- ☐ The employee will be a witness in a criminal proceeding.
Route B — crime victim
- ☐ Employee is a crime victim under § 54-85b.
- ☐ Employee will attend a court proceeding related to the criminal case; or
- ☐ Employee will participate in a police investigation related to the criminal case.
For this section, “crime victim” includes an employee suffering direct or threatened physical, emotional, or financial harm from a crime. It also includes an employee who is an immediate-family member or guardian of a harmed minor, physically disabled person, or incompetent person, or of a homicide victim.
Route C — family-violence victim in a civil case
- ☐ Employee is a victim of family violence as defined in Conn. Gen. Stat. § 46b-38a.
- ☐ Employee will attend or participate in a court proceeding related to the civil case.
Coverage confirmed by prosecutor, advocate, or counsel: [NAME / OFFICE / DATE]
3. PROCEEDING AND ABSENCE
Court, police agency, or location: [________________________________]
Case or incident identifier, using the minimum information needed: [________________________________]
Date and time: [________________________________]
Expected work absence: [DATE / START / END]
Operational notice date, method, and recipient: [________________________________]
Section 54-85b states no fixed advance-notice deadline for these attendance routes.
Employee signature: __________________________ Date: ______________
4. MINIMUM SUPPORTING RECORD
- ☐ Criminal subpoena
- ☐ Court scheduling notice
- ☐ Police-investigation participation request
- ☐ Prosecutor, advocate, or counsel confirmation
- ☐ Other minimally necessary record: [________________________________]
Do not attach police reports, medical records, victim addresses, or detailed offense narratives unless current law or counsel requires them.
5. PAY AND SCHEDULING
Section 54-85b protects employment but does not specify paid leave.
- ☐ Unpaid time
- ☐ Accrued paid leave: [TYPE / HOURS]
- ☐ Schedule adjustment: [________________________________]
- ☐ Other treatment under policy, agreement, or separate law: [________________________________]
6. EMPLOYER RESPONSE
- ☐ Route A, B, or C confirmed
- ☐ Minimum support received or not requested
- ☐ Absence recorded: [________________________________]
- ☐ Pay treatment recorded
- ☐ Counsel review required
The employer may not deprive the employee of employment, penalize, threaten, or otherwise coerce the employee with respect to employment because of covered conduct.
Employer representative: _____________________ Date: ______________
Decision delivered to employee: [DATE / METHOD]
7. COMPLIANCE RECORD
A Route A violation may constitute criminal contempt. An employee alleging discharge, penalty, threat, or coercion under subsection (a) has 180 days from the occurrence to bring the civil action described in subsection (c), which allows damages, reinstatement or rescission, and a reasonable attorney fee for a prevailing employee.
Issue and counsel referral: [________________________________]
8. CHANGE LOG
| Date | Court / agency update | Employee notice | Revised schedule |
|---|---|---|---|
| [________] | [________________] | [________________] | [________________] |
| [________] | [________________] | [________________] | [________________] |
OFFICIAL SOURCE VERIFIED
About This Template
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Important Notice
This template is provided for informational purposes. It is not legal advice. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on 2026-08-11.
Legal authority: Conn. Gen. Stat. § 54-85b (employment protection for subpoenaed criminal witnesses and specified crime-victim or family-violence participation; penalty and civil remedies)
Last updated: 2026-08-11
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