Crime-Victim and Witness Court-Attendance Leave Request Packet - Michigan
CRIME-VICTIM OR VICTIM-REPRESENTATIVE COURT REQUEST PACKET
Michigan — Mich. Comp. Laws § 780.762
1. EMPLOYEE AND EMPLOYER
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| Employer | [________________________________] |
| Position / department | [________________________________] |
| HR / supervisor contact | [________________________________] |
| Preferred confidential contact | [________________________________] |
2. SELECT ONE COVERED ROUTE
Route A — victim giving testimony
- ☐ Employee is the victim.
- ☐ Employee was subpoenaed or requested by the prosecuting attorney to attend court.
- ☐ Attendance is for the purpose of giving testimony.
Route B — victim representative attending victim testimony
- ☐ Employee is a victim representative under § 780.762(3).
- ☐ Employee attends or desires to attend court to be present during the victim's testimony.
Victim-representative category:
- ☐ Guardian or custodian of a deceased victim's child under age 18
- ☐ Parent, guardian, or custodian of an assaultive-crime victim under age 18
- ☐ Person designated under § 780.752(2) to act during an assaultive-crime victim's physical or emotional disability
Coverage confirmed by prosecutor, victim advocate, or counsel: [NAME / OFFICE / DATE]
3. COURT AND ABSENCE
Court: [________________________________]
Case identifier, using the minimum information needed: [________________________________]
Date and time: [________________________________]
Expected work absence: [DATE / START / END]
Operational notice date, method, and recipient: [________________________________]
Employee signature: __________________________ Date: ______________
4. MINIMUM SUPPORTING RECORD
- ☐ Subpoena
- ☐ Prosecuting-attorney request
- ☐ Prosecutor or victim-advocate confirmation of representative attendance
- ☐ Other minimally necessary record: [________________________________]
Do not attach police reports, medical records, victim addresses, or offense narratives when the selected record is sufficient.
5. PAY AND SCHEDULING
Section 780.762 does not specify paid leave.
- ☐ Unpaid time
- ☐ Accrued paid leave: [TYPE / HOURS]
- ☐ Schedule adjustment: [________________________________]
- ☐ Other treatment: [________________________________]
6. EMPLOYER RESPONSE
- ☐ Route A or B confirmed
- ☐ Absence recorded: [________________________________]
- ☐ Pay treatment recorded
- ☐ Counsel review required
The employer or its agent may not threaten, discharge, or discipline a covered victim, and may not threaten, discharge, or discipline a covered victim representative for the activity described above. A violation may be a misdemeanor punishable by up to 90 days' imprisonment, a fine up to $500, or both, and may be punished as contempt of court.
Employer representative: _____________________ Date: ______________
7. CHANGE LOG
| Date | Court update | Employee notice | Revised schedule |
|---|---|---|---|
| [________] | [________________] | [________________] | [________________] |
| [________] | [________________] | [________________] | [________________] |
OFFICIAL SOURCE VERIFIED
About this template
- Last updated
- August 11, 2026
- Citations checked
- August 11, 2026
- Jurisdiction
- Michigan
- Category
- Employment & HR
Legal authority
- Mich. Comp. Laws § 780.762 (employment protection for a victim subpoenaed or prosecutor-requested to testify and for specified victim representatives attending victim testimony; penalties)
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on August 11, 2026.
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