Crime-Victim and Witness Court-Attendance Leave Request Packet

SUBPOENAED CRIME-VICTIM OR WITNESS ATTENDANCE REQUEST PACKET

Massachusetts — Mass. Gen. Laws ch. 258B, § 3(k)-(l)

1. EMPLOYEE AND EMPLOYER

2. COVERAGE GATE

• ☐ Employee is a victim or witness.
• ☐ Employee received a subpoena to testify.
• ☐ Attendance is as a witness at a criminal proceeding.

Do not use the protected-attendance route for a voluntary civil appearance, jury service, an investigation interview without a subpoena, or a non-testimonial proceeding.

3. PROCEEDING AND ABSENCE

Court: [________________________________]

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

Proceeding date and time: [________________________________]

Expected work absence: [DATE / START / END]

Travel or waiting time requested: [________________________________]

4. PRIOR EMPLOYER NOTICE

Chapter 258B, section 3(l) protects a subpoenaed victim or witness who notifies the employer of the subpoena before attending.

Notice date and time: [________________________________]

Notice method and recipient: [________________________________]

• ☐ Copy of subpoena delivered securely
• ☐ Minimum scheduling confirmation delivered

Employee signature: __________________________ Date: ______________

5. PROSECUTOR INTERCESSION REQUEST

Section 3(k) provides appropriate employer intercession services by the prosecutor to seek cooperation in minimizing loss of pay and other benefits resulting from participation in the criminal justice process.

• ☐ Employee requests prosecutor / victim-witness program intercession.
• ☐ Intercession is not requested at this time.

Prosecutor or program contact: [________________________________]

Requested employer contact or scheduling assistance: [________________________________]

Intercession seeks cooperation; it does not itself guarantee paid leave.

6. MINIMUM DISCLOSURE AND PAY

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

Pay treatment:

• ☐ Unpaid time
• ☐ Accrued paid leave: [TYPE / HOURS]
• ☐ Schedule adjustment: [________________________________]
• ☐ Other treatment under policy, agreement, or separate law: [________________________________]

7. EMPLOYER RESPONSE

• ☐ Victim or witness status confirmed with minimum disclosure
• ☐ Criminal-testimony subpoena confirmed
• ☐ Prior notice recorded
• ☐ Absence recorded: [________________________________]
• ☐ Prosecutor intercession contact received / pending
• ☐ Counsel review required

A covered employee must be free from discharge, penalty, or threats of discharge or penalty because of attendance as a subpoenaed witness at a criminal proceeding.

Employer representative: _____________________ Date: ______________

Decision delivered to employee: [DATE / METHOD]

8. CHANGE LOG

OFFICIAL SOURCE VERIFIED

• Massachusetts Legislature — Mass. Gen. Laws ch. 258B, § 3