Crime-Victim and Witness Court-Attendance Leave Request Packet - Iowa

COVERED WITNESS OR CIVIL-PROCEEDING ABSENCE REQUEST PACKET

Iowa — Iowa Code § 915.23

Use this packet only for service as a witness in a criminal proceeding or as a plaintiff, defendant, or witness in a civil proceeding expressly covered by section 915.23.

1. EMPLOYEE AND EMPLOYER

2. COVERED-SERVICE GATE

• ☐ Employee will serve as a witness in a criminal proceeding.
• ☐ Employee will serve as a plaintiff in a civil proceeding expressly covered by section 915.23.
• ☐ Employee will serve as a defendant in a civil proceeding expressly covered by section 915.23.
• ☐ Employee will serve as a witness in a civil proceeding expressly covered by section 915.23.

Court: [________________________________]

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

Service or appearance date and time: [________________________________]

Expected work absence: [DATE / START / END]

Coverage confirmation by counsel, court personnel, or advocate: [________________________________]

3. EMPLOYEE REQUEST

I request an absence from [START] through [END] on [DATE] for the covered service identified above.

Pay or leave-bank request under policy, agreement, or another law:

• ☐ Accrued paid leave: [TYPE / HOURS]
• ☐ Unpaid time
• ☐ Schedule adjustment: [________________________________]
• ☐ Counsel review: [________________________________]

Section 915.23 protects wages and benefits for actual time worked; it does not state that the time away for covered service must be paid.

Employee signature: __________________________ Date: ______________

4. MINIMUM DOCUMENT DELIVERY

• ☐ Subpoena, summons, or court notice, if issued
• ☐ Scheduling or cancellation notice
• ☐ Other minimally necessary confirmation: [________________________________]

Do not attach police reports, medical records, victim addresses, or offense narratives unless current law or counsel requires them.

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

5. EMPLOYER REVIEW

Because of the covered service, section 915.23 prohibits an employer from discharging the employee, taking or failing to take action regarding the employee's promotion or proposed promotion, or reducing the employee's wages or benefits for actual time worked. The section does not use a broader general-leave or all-retaliation formulation.

• ☐ Covered service confirmed
• ☐ Requested absence approved under policy, agreement, or other law
• ☐ Schedule adjusted
• ☐ Pay / leave-bank treatment: [________________________________]
• ☐ Promotion, actual-work pay, and benefit safeguards reviewed
• ☐ Counsel review required

A violation is a simple misdemeanor. The statute also provides an employee damages, including actual damages, court costs, and reasonable attorney fees, and permits a petition for a cease-and-desist order and reinstatement to the previous position.

Employer representative: _____________________ Date: ______________

Decision delivered to employee: [DATE / METHOD]

6. CHANGE LOG

OFFICIAL SOURCE VERIFIED

• Iowa Legislature — Iowa Code § 915.23 (2026 Code)