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

Virginia Employment & HR Updated October 22, 2026 Free Word and PDF

CRIME-VICTIM COURT-ATTENDANCE LEAVE REQUEST PACKET

Virginia — Va. Code § 40.1-28.7:2

Use this packet only for an employee who qualifies as a victim under Va. Code § 19.2-11.01(B) and seeks to attend a covered criminal proceeding relating to the crime against that employee. Do not use this route merely because an employee is an ordinary witness, has a civil hearing, or received a jury summons.

1. EMPLOYEE AND EMPLOYER

Field Entry
Employee [________________________________]
Employer [________________________________]
Position / department [________________________________]
HR / supervisor contact [________________________________]
Preferred confidential contact [________________________________]

2. VICTIM-STATUS GATE

Check the applicable Va. Code § 19.2-11.01(B) route after review with the prosecutor, victim-witness program, or counsel:

  • ☐ Employee suffered physical, psychological, or economic harm directly from a felony, an offense specifically listed in § 19.2-11.01(B), or a covered delinquent act.
  • ☐ Employee is a spouse or child included in the statutory victim definition.
  • ☐ Employee is the parent or legal guardian of a minor victim.
  • ☐ Employee is a qualifying spouse, parent, sibling, or legal guardian of a victim who is incapacitated or was a homicide victim.
  • ☐ Other statutory victim route confirmed by: [NAME / OFFICE / DATE].
  • ☐ The exclusion for a family member who committed the offense does not apply.

An indirect-victim relationship under § 19.2-11.01(B) alone does not establish leave eligibility: § 40.1-28.7:2(B) also requires a criminal proceeding relating to a crime against the employee.

Do not attach charging papers, police reports, medical records, a victim address, or narrative evidence to this packet unless current law or counsel specifically requires it.

3. CRIMINAL-PROCEEDING GATE

The employee requests leave for a criminal proceeding involving a crime against the employee at which the employee has the right or opportunity to appear. The listed proceedings are examples, not the full statutory scope:

  • ☐ Initial appearance of the suspected offender
  • ☐ Post-arrest release or release-condition proceeding
  • ☐ Presentation of a negotiated plea
  • ☐ Sentencing
  • ☐ Postconviction release-from-confinement proceeding
  • ☐ Probation revocation disposition or requested probation termination
  • ☐ Requested probation modification substantially affecting victim contact, safety, restitution, or incarceration status
  • ☐ Another qualifying criminal proceeding at which the victim has the right or opportunity to appear: [DESCRIBE]

Court / tribunal: [________________________________]

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

Proceeding date and scheduled time: [________________________________]

Expected work absence: [DATE / START / END]

4. REQUIRED DOCUMENT DELIVERY

Va. Code § 40.1-28.7:2(B) conditions this leave route on delivery of the applicable documents.

  • ☐ Copy of the standardized victim-rights form supplied by law enforcement under Va. Code § 19.2-11.01(A)
  • ☐ Copy of the notice of this scheduled criminal proceeding, if applicable

Delivery date: [________________________________]

Secure delivery method and recipient: [________________________________]

The employee requests that the employer restrict these records to personnel who need them to administer the absence. This privacy request does not alter any disclosure required by law.

5. EMPLOYEE REQUEST

I request leave from [START] through [END] on [DATE] to attend the criminal proceeding identified above.

If the requested period creates a significant operational difficulty, please contact me promptly to discuss a lawful limitation or scheduling adjustment that still permits attendance to the extent practicable.

Pay selection:

  • ☐ Unpaid time under this statutory route
  • ☐ Apply available accrued paid leave if permitted by policy or another law: [TYPE / HOURS]
  • ☐ Other pay treatment reviewed by HR or counsel: [________________________________]

Va. Code § 40.1-28.7:2 does not require compensation for the covered absence.

Employee signature: __________________________ Date: ______________

6. EMPLOYER REVIEW

  • ☐ Victim route confirmed
  • ☐ Covered criminal proceeding confirmed
  • ☐ Standardized law-enforcement form received
  • ☐ Proceeding notice received, if applicable
  • ☐ Leave approved as requested
  • ☐ Leave limited because the requested absence creates an undue hardship as defined by § 40.1-28.7:2
  • ☐ Counsel review required

If leave is limited, identify the significant difficulty and expense, including the size of the business and the critical need for the employee, without requesting unnecessary victim information:

[____________________________________________________________]

Alternative or limited schedule offered: [________________________________]

Final approved absence: [________________________________]

Pay / leave-bank treatment: [________________________________]

Va. Code § 40.1-28.7:2 prohibits dismissal and other listed employment discrimination because an individual uses covered leave to attend a criminal proceeding.

Employer representative: _____________________ Date: ______________

Decision delivered to employee: [DATE / METHOD]

7. CHANGE OR CANCELLATION LOG

Date Court update Employee notice to employer Revised work schedule
[________] [________________] [________________] [________________]
[________] [________________] [________________] [________________]

OFFICIAL SOURCES VERIFIED

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About this template

Last updated
October 22, 2026
Citations checked
October 22, 2026
Jurisdiction
Virginia
Category
Employment & HR

Legal authority

  • Va. Code § 40.1-28.7:2 (crime-victim leave for covered criminal proceedings; required documents, undue-hardship limit, pay, and employment protection)
  • Va. Code § 19.2-11.01(B) (incorporated definition of victim)

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 October 22, 2026.

Va. Code § 40.1-28.7:2(A) (checked October 22, 2026): ""Criminal proceedings" means a proceeding at which the victim has the right or opportunity to appear involving a crime against the victim, including:"

Va. Code § 40.1-28.7:2(A) (undue hardship) (checked October 22, 2026): ""Undue hardship" means a significant difficulty and expense to a business and includes the consideration of the size of the employer's business and the employer's critical need of the employee."

Va. Code § 40.1-28.7:2(B) (checked October 22, 2026): "Every employer shall allow an employee who is a victim of a crime to leave work to be present at all criminal proceedings relating to a crime against the employee, as long as the employee has provided the employer with a copy of the form provided to the employee by the law-enforcement agency pursuant to subsection A of § 19.2-11.01 and, if applicable, provided the employer a copy of the notice of each scheduled criminal proceeding that is provided to the employee as victim."

Va. Code § 40.1-28.7:2(D) (checked October 22, 2026): "An employer is not required to compensate an employee who is a victim of a crime when the employee leaves work pursuant to subsection B."

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