Crime-Victim and Witness Court-Attendance Leave Request Packet

UNPAID VICTIM-LEAVE LEGAL-ACTION REQUEST PACKET

Hawaii — Haw. Rev. Stat. §§ 378-71 to 378-74

Use this packet when an eligible employee needs unpaid victim leave to prepare for or participate in a civil or criminal legal proceeding related to or resulting from domestic abuse, sexual assault, or stalking affecting the employee or the employee's minor child.

1. EMPLOYEE AND EMPLOYER

• ☐ Employee has performed services for hire for this employer for at least six consecutive months.
• ☐ Eligibility is uncertain; counsel review required.

2. VICTIM AND LEGAL-ACTION GATE

The victim is:

• ☐ Employee
• ☐ Employee's minor biological, adopted, or foster child
• ☐ Employee's minor stepchild
• ☐ Employee's minor legal ward

The related conduct is:

• ☐ Domestic abuse
• ☐ Sexual assault
• ☐ Stalking

The requested absence is necessary to:

• ☐ Prepare for a related civil legal proceeding
• ☐ Participate in a related civil legal proceeding
• ☐ Prepare for a related criminal legal proceeding
• ☐ Participate in a related criminal legal proceeding
• ☐ Take another qualifying legal action to enhance health or safety: [________________________________]

Court, counsel, advocate, or proceeding: [________________________________]

Case or matter identifier, using the minimum necessary information: [________________________________]

Activity date and time: [________________________________]

Expected work absence: [DATE / START / END]

3. LEAVE AMOUNT AND OTHER-LEAVE COORDINATION

Select the employer-size tier:

• ☐ 50 or more employees — up to 30 days of unpaid victim leave per calendar year
• ☐ 49 or fewer employees — up to 5 days of unpaid victim leave per calendar year

The legal-action leave period should be the time necessary to complete the activity as determined by the employee's or minor child's attorney or advocate, the court, or personnel of the relevant victim-services organization, subject to the annual cap.

Available paid or unpaid leave under another federal, state, or county law, employment agreement, collective bargaining agreement, or benefits plan that may be used for this purpose must be exhausted before statutory victim leave is applied. The combined leave may not exceed the applicable section 378-72 cap.

4. REASONABLE NOTICE AND STATUS REPORTING

The employee must provide reasonable notice of the intention to take leave unless notice is not practicable because of imminent danger to the employee or minor child.

• ☐ Reasonable advance notice provided
• ☐ Notice was not practicable because of imminent danger

Notice date, time, method, and recipient: [________________________________]

Minimum necessary explanation: [________________________________]

An employer may require an employee on victim leave to report at least once each week on status and intent to return.

Agreed confidential reporting method and day: [________________________________]

5. NON-MEDICAL CERTIFICATION, IF REQUESTED

For not more than five calendar days of non-medical leave, the employee provides a signed statement within a reasonable time after the employer requests certification.

• ☐ Signed employee statement: the employee or minor child is a victim and the leave serves a purpose listed in section 378-72(a)

If leave exceeds five days in the calendar year, select one documentation route:

• ☐ Certified or exemplified restraining order, injunction against harassment, or criminal-case document
• ☐ Documentation from a victim-services organization, domestic- or sexual-violence program, agency, facility, shelter, or safe house
• ☐ Documentation from a medical professional, mental-health provider, attorney, advocate, social worker, or clergy member from whom assistance was sought

If certification is required, statutory leave protection does not begin until the certification is provided.

Secure delivery date, method, and recipient: [________________________________]

Provide only the minimum documentation necessary. Do not attach police reports, medical records, victim addresses, or offense narratives unless current law or counsel requires them.

6. EMPLOYEE REQUEST

I request the coordinated leave recorded above for the qualifying legal action identified in this packet.

Employee signature: __________________________ Date: ______________

7. EMPLOYER RESPONSE, CONFIDENTIALITY, AND RESTORATION

• ☐ Six-consecutive-month service requirement confirmed
• ☐ Employee or minor-child victim gate confirmed
• ☐ Qualifying legal-action purpose confirmed
• ☐ Employer-size cap and calendar-year usage confirmed
• ☐ Other qualifying leave coordinated and exhausted
• ☐ Notice route confirmed
• ☐ Certification not requested, received, or calendared
• ☐ Unpaid victim leave approved: [DAYS / DATES]
• ☐ Weekly confidential reporting arrangement recorded
• ☐ Return to original job or comparable status and pay confirmed
• ☐ Accumulated service credits and privileges preserved as section 378-72(h) requires
• ☐ Greater rights under an agreement, bargaining agreement, program, or plan preserved
• ☐ Counsel review required

All information, records, corroborating evidence, victim status, and the fact of a leave request must be kept in the strictest confidence. Disclosure is limited to employee request or consent, a court or administrative-agency order, or another applicable federal or state law.

An employee denied leave in a willful violation may bring a civil action to enforce section 378-72 and recover civil-action costs, including reasonable attorney fees.

Employer representative: _____________________ Date: ______________

Decision delivered to employee: [DATE / METHOD]

8. CHANGE LOG

OFFICIAL SOURCES VERIFIED

• Hawaii State Legislature — HRS § 378-71
• Hawaii State Legislature — HRS § 378-72
• Hawaii State Legislature — HRS § 378-73
• Hawaii State Legislature — HRS § 378-74