Crime-Victim and Witness Court-Attendance Leave Request Packet

VICTIM OR WITNESS EMPLOYER-INTERCESSION REQUEST PACKET

Oklahoma — 21 Okla. Stat. § 142A-2(A)(8)

Important: This is an intercession request, not a statutory leave-demand form.

1. EMPLOYEE AND EMPLOYER

2. SERVICE GATE

• ☐ Employee is a victim.
• ☐ Employee is a witness.
• ☐ Employee requests appropriate employer-intercession services.

Status confirmed by district attorney or victim-witness program: [NAME / OFFICE / DATE]

3. COURT APPEARANCE AND WORK IMPACT

Court: [________________________________]

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

Appearance date and time: [________________________________]

Expected work absence: [DATE / START / END]

Expected pay or benefit impact: [________________________________]

Employee's operational notice to employer: [DATE / METHOD / RECIPIENT]

4. INTERCESSION REQUEST

The employee requests services to seek employer cooperation with the criminal-justice process and minimize loss of pay and other benefits resulting from court appearances.

• ☐ Confirm appearance and expected timing.
• ☐ Seek a schedule adjustment.
• ☐ Seek voluntary paid-leave use.
• ☐ Seek minimization of benefit loss.
• ☐ Address a cancellation or rescheduling.
• ☐ Other: [________________________________]

Employee signature: __________________________ Date: ______________

5. MINIMUM SUPPORTING RECORD

• ☐ Court or district-attorney scheduling notice
• ☐ Subpoena, if applicable
• ☐ Victim-witness program confirmation
• ☐ Other minimally necessary record: [________________________________]

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

6. EMPLOYER COOPERATION RESPONSE

The cited provision does not itself impose mandatory leave or pay.

• ☐ Absence approved under policy or agreement: [________________________________]
• ☐ Schedule adjusted: [________________________________]
• ☐ Accrued paid leave applied: [TYPE / HOURS]
• ☐ Unpaid time: [________________________________]
• ☐ Benefits impact minimized: [________________________________]
• ☐ Separate legal protection requires counsel review: [________________________________]

Employer representative: _____________________ Date: ______________

Intercession contact: _________________________ Date: ______________

7. CHANGE LOG

OFFICIAL SOURCE VERIFIED

• Oklahoma State Courts Network — 21 Okla. Stat. § 142A-2