Crime-Victim and Witness Court-Attendance Leave Request Packet - North Carolina

VICTIM/WITNESS INTERCESSION AND PROTECTIVE-RELIEF TIME-OFF PACKET

North Carolina — N.C. Gen. Stat. §§ 15A-824–825, 50B-5.5, 95-241, 95-270

Use Part A for victim, qualifying witness, or homicide-family employer intercession. Use Part B for reasonable time off to obtain or attempt to obtain relief under Chapter 50B or 50C. Do not present Part A alone as mandatory leave or pay.

1. EMPLOYEE AND EMPLOYER

PART A — VICTIM OR WITNESS EMPLOYER INTERCESSION

2A. ARTICLE 45 STATUS GATE

Confirm the applicable status under section 15A-824:

• ☐ Victim: there is probable cause to believe a covered crime was committed against the employee.
• ☐ Witness: the employee is or is expected to be summoned for the prosecution in a felony action, or has relevant information and is subject or likely to be called for the prosecution.
• ☐ Family member of a homicide victim: spouse, child, parent, guardian, legal custodian, sibling, or grandparent, excluding the accused.

Covered-crime and status confirmation by district attorney, law enforcement, victim-witness program, counsel, or court personnel: [________________________________]

Section 15A-824 defines “crime” for this Article and gives the district attorney sole discretion over whether a misdemeanor is a serious misdemeanor. Obtain confirmation rather than making that determination in this form.

3A. CRIMINAL-JUSTICE COOPERATION

Agency, prosecutor's office, or court: [________________________________]

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

Cooperation or appearance date and time: [________________________________]

Expected work absence: [DATE / START / END]

• ☐ Subpoena or notice securely presented, if issued
• ☐ Scheduling confirmation securely presented
• ☐ Cancellation or continuance updates requested

4A. INTERCESSION REQUEST

I request appropriate employer-intercession services under section 15A-825(a)(4) to seek my employer's cooperation with the criminal-justice system and, whenever possible, minimize loss of pay and other benefits resulting from that cooperation.

Requested limited contact:

• ☐ Explain the criminal-justice cooperation need
• ☐ Confirm the date and expected duration
• ☐ Request a schedule adjustment
• ☐ Request consideration of available paid leave
• ☐ Request consideration of unpaid time
• ☐ Request treatment under an applicable policy or agreement
• ☐ Provide an update if the event is canceled or continued
• ☐ Other limited coordination: [________________________________]

Employee authorizes limited employer contact by: [________________________________]

Employee signature: __________________________ Date: ______________

The statutory service is subject to what is reasonably possible, available resources, and a reasonable-effort standard. Section 15A-825 does not itself create a cause of action for noncompliance and does not itself command leave or pay.

5A. INTERCESSION RECORD

Intercession provider: ________________________ Date: ______________

PART B — REASONABLE TIME OFF FOR PROTECTIVE RELIEF

2B. PROTECTED-RELIEF GATE

• ☐ The employee took or requests reasonable time off to obtain or attempt to obtain relief under Chapter 50B.
• ☐ The employee took or requests reasonable time off to obtain or attempt to obtain relief under Chapter 50C.
• ☐ The requested duration is limited to the time reasonably needed.

Court or filing office: [________________________________]

Proceeding or filing date and time: [________________________________]

Expected work absence: [DATE / START / END]

Do not use this packet to determine eligibility for relief under Chapter 50B or 50C. Confirm the applicable court route with counsel or an advocate.

3B. NOTICE AND DOCUMENTATION

• ☐ The employee followed the employer's usual time-off policy or procedure.
• ☐ Advance notice was given as required by the usual procedure.
• ☐ An emergency prevented advance compliance with the usual procedure.
• ☐ Available information supporting the reason for absence is securely provided.
• ☐ Available documentation of the emergency is securely provided, if requested.

Minimum supporting information: [________________________________]

Do not attach a petition narrative, medical record, protected address, or other sensitive material when a less revealing scheduling record is sufficient.

4B. EMPLOYEE NOTICE

I request reasonable time off to obtain or attempt to obtain relief under Chapter [50B / 50C]. Sections 50B-5.5 and 95-270 restrict discharge, demotion, denial of promotion, or discipline because an employee took covered reasonable time off. Section 95-241(a)(5) separately protects good-faith exercise of Chapter 50B rights.

Requested workplace treatment:

• ☐ Schedule adjustment
• ☐ Available paid-leave use
• ☐ Unpaid time
• ☐ Other policy or agreement treatment: [________________________________]

These statutes do not themselves state that the time off is paid.

Employee signature: __________________________ Date: ______________

5B. EMPLOYER RESPONSE

• ☐ Chapter 50B route recorded
• ☐ Chapter 50C route recorded
• ☐ Usual-procedure compliance confirmed
• ☐ Emergency exception recorded
• ☐ Reasonable time off recorded without discharge, demotion, promotion denial, or discipline because of the covered absence
• ☐ Schedule adjusted
• ☐ Paid leave available: [TYPE / HOURS]
• ☐ Unpaid time available: [HOURS]
• ☐ Additional available supporting information requested
• ☐ Counsel review required

Employer representative: _____________________ Date: ______________

6. ENFORCEMENT-DEADLINE ALERT

Sections 50B-5.5 and 95-270 direct enforcement through Article 21 of Chapter 95. Section 95-242 generally requires a written complaint to the Commissioner of Labor within 180 days of the alleged violation. Section 95-243 generally requires an employee civil action within 90 days after issuance of a right-to-sue letter and lists injunctive, reinstatement, benefit, seniority, economic-loss, and possible fee relief. The 2026 complaint-content rules are detailed and time-sensitive; obtain prompt legal advice rather than relying on this packet as a complaint.

7. CHANGE LOG

OFFICIAL SOURCES VERIFIED

• North Carolina General Assembly — N.C. Gen. Stat. § 15A-824
• North Carolina General Assembly — N.C. Gen. Stat. § 15A-825
• North Carolina General Assembly — N.C. Gen. Stat. § 50B-5.5
• North Carolina General Assembly — N.C. Gen. Stat. § 95-241
• North Carolina General Assembly — N.C. Gen. Stat. § 95-242
• North Carolina General Assembly — N.C. Gen. Stat. § 95-243
• North Carolina General Assembly — N.C. Gen. Stat. § 95-270
• North Carolina General Assembly — Session Law 2026-13