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

ALLEGED CRIME-VICTIM PROCEEDING-ATTENDANCE LEAVE REQUEST PACKET

Vermont — 21 V.S.A. § 472c

1. EMPLOYEE AND EMPLOYER

2. EMPLOYEE AND ALLEGED-VICTIM GATES

• ☐ Employee has been continuously employed by this employer for at least six months.
• ☐ Employee averaged at least 20 hours per week.
• ☐ Employee is an alleged victim as defined in § 472c(a)(1).

If the employee relies on the family-member route, confirm that the directly harmed person is a minor, has been found incompetent, allegedly suffered physical or emotional injury from a violent crime or delinquent act, or was killed, and that the relationship is within the statute.

Coverage confirmed by prosecutor, victim advocate, or counsel: [NAME / OFFICE / DATE]

3. SELECT COVERED PROCEEDING

• ☐ Criminal proceeding where the employee is an alleged victim with a right or obligation to appear
• ☐ Relief-from-abuse hearing under 15 V.S.A. § 1103 where employee is plaintiff
• ☐ Stalking or sexual-assault order hearing under 12 V.S.A. § 5133 where employee is plaintiff
• ☐ Abuse, neglect, or exploitation hearing under 33 V.S.A. chapter 69 where employee is plaintiff

Appearance type: ☐ deposition ☐ court proceeding

Court / location: [________________________________]

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

Date and time: [________________________________]

Expected work absence: [DATE / START / END]

Employee signature: __________________________ Date: ______________

4. MINIMUM SUPPORTING RECORD

• ☐ Court or deposition notice
• ☐ Subpoena or order, if applicable
• ☐ Prosecutor, advocate, or counsel confirmation of alleged-victim route
• ☐ Other minimally necessary record: [________________________________]

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

5. PAY, BENEFITS, AND RETURN

Leave is unpaid. At the employee's option, accrued sick, vacation, or other paid leave may be used, but using paid leave does not extend the leave. Employment benefits continue at the statutory level and conditions, subject to the existing employee contribution rate.

• ☐ Unpaid leave
• ☐ Employee elects accrued paid leave: [TYPE / HOURS]
• ☐ Benefits continuation recorded
• ☐ Same or comparable job return recorded

6. BUSINESS-OPERATIONS EXCEPTION

The leave entitlement does not apply to an employer providing goods or services to the public if the employee's absence would require suspension of all business operations at a location open to the public.

• ☐ Exception does not apply
• ☐ Counsel review required before relying on exception

Exception facts and alternatives considered: [________________________________]

7. EMPLOYER RESPONSE

• ☐ Employee and alleged-victim gates confirmed
• ☐ Covered proceeding confirmed
• ☐ Leave approved: [________________________________]
• ☐ Pay, benefits, and return treatment recorded
• ☐ Lawful exception reviewed: [________________________________]

Employer representative: _____________________ Date: ______________

8. CHANGE LOG

OFFICIAL SOURCE VERIFIED

• Vermont General Assembly — 21 V.S.A. § 472c