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

DOMESTIC-VIOLENCE OR SEXUAL-ASSAULT COURT-APPEARANCE TIME-OFF PACKET

Kansas — K.S.A. § 44-1132(a)(4)

Use this packet only for an employee who is a victim of domestic violence or sexual assault and seeks time off to make a court appearance in the aftermath of that violence or assault.

1. EMPLOYEE AND EMPLOYER

2. COVERED COURT-APPEARANCE GATE

• ☐ Employee is a victim of domestic violence.
• ☐ Employee is a victim of sexual assault.
• ☐ The requested time off is to make a court appearance in the aftermath of that violence or assault.

Court: [________________________________]

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

Appearance date and time: [________________________________]

Expected work absence: [DATE / START / END]

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

3. NOTICE ROUTE

Scheduled absence

The employee must give reasonable advance notice unless advance notice is not feasible. Within 48 hours after returning from the requested time off, the employee must provide supporting documentation.

• ☐ Reasonable advance notice delivered
• ☐ Advance notice was not feasible; reason recorded with minimum necessary detail: [________________________________]
• ☐ Supporting-document deadline calendared for 48 hours after return

Unscheduled absence

For an unscheduled absence, section 44-1132(b)(2) protects the employee from employer action if the employee provides a qualifying certification within 48 hours after the absence begins.

• ☐ Unscheduled-absence route applies
• ☐ Certification deadline calendared for 48 hours after absence began

Notice or absence start: [DATE / TIME]

Delivery date, method, and recipient: [________________________________]

4. MINIMUM SUPPORTING DOCUMENT

For a scheduled absence, § 44-1132(b)(1) permits supporting documentation beyond the examples in (b)(2). For an unscheduled absence, the 48-hour certification must use one of the forms listed in (b)(2): a qualifying police report, court order or court/prosecutor evidence, or qualifying medical, advocate, health-care-provider, or counselor documentation. For a court appearance, court or prosecutor evidence of appearance is usually the direct proof.

• ☐ Court order securely presented
• ☐ Court evidence securely presented
• ☐ Prosecuting-attorney evidence securely presented
• ☐ Other minimally necessary support for a scheduled absence under (b)(1): [________________________________]

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

To the extent allowed by law, the employer must maintain the confidentiality of the request and supporting documentation.

Secure storage location or access restriction: [________________________________]

5. EMPLOYEE REQUEST AND LEAVE TREATMENT

I request time off from [START] through [END] on [DATE] for the covered court appearance identified above.

Section 44-1132(d) permits use of accrued paid leave or, if paid leave is unavailable, unpaid leave. The statutory total is no more than eight days per calendar year unless a longer period is available under the applicable terms of employment or a collective bargaining agreement.

• ☐ Accrued paid leave requested: [TYPE / HOURS]
• ☐ Paid leave is unavailable; unpaid time requested: [HOURS]
• ☐ Longer period available under employment terms or collective bargaining agreement: [________________________________]

Covered days already used this calendar year: [________]

Days requested with this submission: [________]

Employee signature: __________________________ Date: ______________

6. EMPLOYER REVIEW

An employer may not discharge, discriminate, or retaliate against a qualifying employee for taking covered time off. A collective bargaining agreement may not diminish the employee's entitlement under section 44-1132.

• ☐ Victim and court-appearance route confirmed
• ☐ Notice route and deadline confirmed
• ☐ Supporting documentation received or calendared
• ☐ Time off approved as requested
• ☐ Paid / unpaid leave treatment: [________________________________]
• ☐ Eight-day or longer governing allowance confirmed
• ☐ Confidential storage and access controls confirmed
• ☐ Counsel review required

Employer representative: _____________________ Date: ______________

Decision delivered to employee: [DATE / METHOD]

7. CHANGE LOG

OFFICIAL SOURCE VERIFIED

• Kansas Office of Revisor of Statutes — K.S.A. § 44-1132