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

CRIME-VICTIM OR WITNESS EMPLOYER-INTERCESSION REQUEST PACKET

Wisconsin — Wis. Stat. § 950.04(1v)(bm), (2w)(g)

Important: This is an intercession request, not a statutory leave-demand form. The cited provisions call for appropriate intercession services to seek employer cooperation and minimize pay and benefit loss from court appearances.

If the employee was subpoenaed to testify in a crime-related proceeding or one under chapter 48 or 938, Wis. Stat. § 103.87 separately bars discharge because of that subpoena. Give the employer notice by the first business day after receipt of the subpoena. The statute preserves pay only when the subpoena results from a crime against the employer or an incident involving the employee during employment.

1. EMPLOYEE AND EMPLOYER

2. SELECT THE SERVICE ROUTE

• ☐ Victim route. Employee is a victim eligible under Wis. Stat. chapter 950, the crime has been reported to law enforcement as § 950.03 requires, and the employee needs employer intercession concerning a court appearance.
• ☐ Witness route. Employee is a prosecution witness as described in Wis. Stat. § 950.02(5) and needs employer intercession concerning a court appearance.

Victim / witness status confirmed by district attorney or victim-witness office: [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]

Subpoena received, if any: [DATE]; employer notified: [DATE / METHOD / RECIPIENT]

4. REQUEST FOR INTERCESSION SERVICES

The employee asks the district attorney's office, victim-witness office, or other appropriate program to contact the employer to seek cooperation with the criminal or juvenile justice process and minimize loss of pay and benefits from the court appearance.

Requested assistance:

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

Employee signature: __________________________ Date: ______________

5. MINIMUM DISCLOSURE

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

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

Secure delivery date, method, and recipient: [________________________________]

6. EMPLOYER COOPERATION RESPONSE

Section 950.04 intercession does not itself impose general paid leave. For covered subpoenaed testimony, § 103.87 bars discharge because of the subpoena; the employee must give the employer notice by the first business day after receiving it if attendance will require absence from work. The statute also bars decreasing or withholding pay for time lost complying with a subpoena arising from a crime against the employer or an incident involving the employee during employment. Record those protections separately from any additional scheduling or leave arrangement.

• ☐ Subpoenaed testimony in a crime-related proceeding or proceeding under chapter 48 or 938; employer notice given by the first business day after subpoena receipt: [DATE / METHOD]. Employer acknowledges the § 103.87 discharge protection.
• ☐ Statutory pay protection applies: subpoena resulted from ☐ a crime against the employer or ☐ an incident involving Employee during employment. Pay for time lost will not be decreased or withheld: [HOURS / AMOUNT].

• ☐ Statutory pay exception does not apply; pay and scheduling treatment below rests on policy, agreement, or voluntary cooperation.

• ☐ Absence approved under policy or agreement: [________________________________]

• ☐ Schedule adjusted: [________________________________]
• ☐ Accrued paid leave applied: [TYPE / HOURS]
• ☐ Unpaid time: [________________________________]
• ☐ Benefits impact minimized as follows: [________________________________]
• ☐ Other legal protection or agreement identified: [________________________________]

Employer representative: _____________________ Date: ______________

Intercession contact: _________________________ Date: ______________

7. CHANGE LOG

OFFICIAL SOURCE VERIFIED

• Wisconsin Legislature — Wis. Stat. § 950.04
• Wisconsin Legislature — Wis. Stat. § 950.02 definitions
• Wisconsin Legislature — Wis. Stat. § 103.87