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

VICTIM-OF-VIOLENCE COURT-ATTENDANCE LEAVE REQUEST PACKET

Maine — 26 M.R.S. § 850

Use this packet only when reasonable and necessary leave is needed to prepare for or attend court proceedings because the employee or the employee's child, parent, or spouse is a covered victim.

1. EMPLOYEE AND EMPLOYER

2. COVERAGE GATE

Covered person:

• ☐ Employee
• ☐ Employee's child
• ☐ Employee's parent
• ☐ Employee's spouse

Covered basis confirmed by counsel or advocate:

• ☐ Violence or assault
• ☐ Sexual assault under Title 17-A, chapter 11
• ☐ Stalking
• ☐ Act that would support a protection order under Title 19-A, chapter 103

If family status is used, the employer may request reasonable relationship documentation under subsection 1-A. Use the least intrusive adequate record.

3. COURT-PROCEEDING AND WORK IMPACT

• ☐ Preparation for a court proceeding
• ☐ Attendance at a court proceeding

Court: [________________________________]

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

Proceeding date and time: [________________________________]

Expected work absence: [DATE / START / END]

Notice to employer was provided within a reasonable time under the circumstances on: [DATE / METHOD]

4. EMPLOYEE REQUEST

I request reasonable and necessary leave from [START] through [END] on [DATE] for the covered court purpose identified above.

Pay and benefits require careful review. Section 850 describes leave as with or without pay and also restricts sanction or deprivation of pay or benefits for exercising the statutory right. Requested treatment:

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

Employee signature: __________________________ Date: ______________

5. MINIMUM DOCUMENT DELIVERY

• ☐ Court scheduling notice
• ☐ Advocate or attorney confirmation
• ☐ Reasonable family-relationship documentation, if requested
• ☐ Other minimally necessary record: [________________________________]

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

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

6. EMPLOYER REVIEW

• ☐ Covered person and violence route confirmed
• ☐ Leave is reasonable and necessary
• ☐ Request was communicated within a reasonable time
• ☐ Leave approved as requested
• ☐ Leave limited because absence would create undue hardship
• ☐ Request limited because it is impractical, unreasonable, or unnecessary on the facts made known
• ☐ Pay / benefits treatment reviewed by counsel: [________________________________]

Section 850 applies to public and private employers. A denial may be subject to Department of Labor penalties when statutory notice is given within six months, and termination has separate remedial options.

Employer representative: _____________________ Date: ______________

Decision delivered to employee: [DATE / METHOD]

7. CHANGE LOG

OFFICIAL SOURCE VERIFIED

• Maine Legislature — 26 M.R.S. § 850