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

VICTIM/WITNESS INTERCESSION AND PROTECTED LEGAL-PROCEEDING LEAVE PACKET

Washington — RCW 7.69.030 and chapter 49.76 RCW

Use Part A for victim, survivor, or witness employer intercession tied to a court appearance. Use Part B for protected leave related to domestic violence, sexual assault, stalking, or hate crime. Part A does not itself convert a court appearance into mandatory paid leave.

1. EMPLOYEE AND EMPLOYER

PART A — CRIME-VICTIM OR WITNESS EMPLOYER INTERCESSION

2A. STATUS AND PROCEEDING GATE

• ☐ The employee is a victim of crime.
• ☐ The employee is a survivor of a victim.
• ☐ The employee is a witness of crime.
• ☐ The matter is an adult criminal proceeding.
• ☐ The matter is a juvenile criminal proceeding.
• ☐ The matter is a civil commitment proceeding under chapter 10.77 or 71.09 RCW.
• ☐ A court appearance will cause work absence or schedule disruption.

Status confirmation by prosecutor, victim-witness program, counsel, court, or issuing party: [________________________________]

3A. COURT APPEARANCE

Court: [________________________________]

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

Appearance date and time: [________________________________]

Expected work absence: [DATE / START / END]

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

4A. EMPLOYER-INTERCESSION REQUEST

I request appropriate employer-intercession services under RCW 7.69.030(1)(i) to support employer cooperation with the applicable criminal-justice or civil-commitment process and minimize loss of pay and other benefits resulting from the court appearance.

Requested limited contact:

• ☐ Explain the court-appearance 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 appearance is canceled or continued
• ☐ Other limited coordination: [________________________________]

Employee authorizes limited employer contact by: [________________________________]

Employee signature: __________________________ Date: ______________

RCW 7.69.030 uses a reasonable-effort structure. If a right under that section is denied, subsection (2) provides an expedited superior-court petition for an order directing compliance; compliance is the sole remedy under that subsection. Obtain counsel before pursuing that route.

5A. INTERCESSION RECORD

Intercession provider: ________________________ Date: ______________

PART B — CHAPTER 49.76 PROTECTED LEAVE

2B. EMPLOYEE OR FAMILY-MEMBER GATE

The employee or a qualifying family member is a victim of:

• ☐ Domestic violence
• ☐ Sexual assault
• ☐ Stalking
• ☐ Hate crime

Relationship, if the victim is a family member:

• ☐ Child
• ☐ Spouse
• ☐ Parent
• ☐ Parent-in-law
• ☐ Grandparent
• ☐ Person with whom the employee has a dating relationship

Do not include incident details that are unnecessary to establish protected status and purpose.

3B. LEAVE PURPOSE AND SCHEDULE

The employee requests reasonable leave to seek legal or law-enforcement assistance or remedies to ensure the health and safety of the employee or a family member, including:

• ☐ Preparing for a related civil legal proceeding
• ☐ Participating in a related civil legal proceeding
• ☐ Preparing for a related criminal legal proceeding
• ☐ Participating in a related criminal legal proceeding
• ☐ Other covered legal or law-enforcement assistance or remedy: [________________________________]

Leave schedule:

• ☐ Continuous leave: [START / END]
• ☐ Intermittent leave: [DATES / BLOCKS]
• ☐ Reduced leave schedule: [HOURS / DAYS]

Chapter 49.76 allows reasonable leave with or without pay. The employee may elect available sick leave and other paid time off, compensatory time, or unpaid leave time.

4B. NOTICE

• ☐ Advance notice given consistent with the employer's stated leave-request policy.
• ☐ Advance notice given; no stated employer policy governs its timing.
• ☐ An emergency or unforeseen circumstance due to domestic violence, sexual assault, stalking, or hate crime prevented advance notice.
• ☐ The employee or designee gave notice no later than the end of the first leave day.

Notice date, time, method, and recipient: [________________________________]

Employee or designee: _________________________ Date: ______________

5B. VERIFICATION

If the employer requires verification, provide one or more permitted forms in a timely manner. When emergency or unforeseen circumstances prevented advance notice, required verification may be provided within a reasonable period during or after leave.

• ☐ Police report
• ☐ Protective or separation court order
• ☐ Other court or prosecuting-attorney evidence of an appearance or scheduled appearance
• ☐ Documentation from an advocate, attorney, clergy member, or medical or other professional
• ☐ Employee's written statement of victim status and covered leave purpose
• ☐ Family-relationship statement or other similar documentation, if applicable

Verification delivered securely on: [DATE / METHOD]

Only information establishing qualifying victim status and the covered leave purpose is required. The employer may not require information beyond that scope or information that would compromise the safety of the employee or family member.

6B. EMPLOYER CONFIDENTIALITY AND RESPONSE

The employer must maintain the confidentiality of victim status, the leave request or use, and all statements, documents, records, or corroborating evidence, except when disclosure is employee-requested or employee-consented, court- or agency-ordered, or otherwise required by applicable law.

• ☐ Leave approved
• ☐ Continuous schedule recorded
• ☐ Intermittent schedule recorded
• ☐ Reduced schedule recorded
• ☐ Paid leave elected: [TYPE / HOURS]
• ☐ Compensatory time elected: [HOURS]
• ☐ Unpaid leave elected: [HOURS]
• ☐ Permitted verification requested
• ☐ Confidential file and access controls applied
• ☐ Counsel review required

Employer representative: _____________________ Date: ______________

7B. RETURN, BENEFITS, AND NONRETALIATION

• ☐ Pay and benefits accrued before leave remain intact.
• ☐ Return to the same position recorded.
• ☐ Return to an equivalent position with equivalent benefits, pay, and terms recorded.
• ☐ Statutory staffing-company or completed-term/project exception requires counsel review.
• ☐ Health-plan coverage maintained to the extent allowed by law, at the applicable level and conditions.
• ☐ No prohibited retaliation or discrimination because the employee exercised chapter 49.76 rights.

RCW 49.76.100 provides a civil action for injunctive relief, actual damages, or both, plus suit costs including reasonable attorney fees, without requiring exhaustion of administrative remedies. Administrative enforcement is also available under RCW 49.76.070–.090.

8. CHANGE LOG

OFFICIAL SOURCES VERIFIED

• Washington State Legislature — RCW 7.69.030
• Washington State Legislature — chapter 49.76 RCW
• Washington State Legislature — 2025 Laws chapter 375, effective January 1, 2026