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.
1. EMPLOYEE AND EMPLOYER
| Field | Entry |
|---|---|
| Employee | [________________________________] |
| Employer | [________________________________] |
| Position / department | [________________________________] |
| HR / supervisor contact | [________________________________] |
| Preferred confidential contact | [________________________________] |
2. SELECT THE SERVICE ROUTE
- ☐ Victim route. Employee is a victim eligible under Wis. Stat. chapter 950 and 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]
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
The cited provisions do not themselves impose mandatory leave or pay. Record the employer's voluntary cooperation and any separate legal or policy basis.
- ☐ Absence approved under policy or agreement: [________________________________]
- ☐ Schedule adjusted: [________________________________]
- ☐ Accrued paid leave applied: [TYPE / HOURS]
- ☐ Unpaid time: [________________________________]
- ☐ Benefits impact minimized as follows: [________________________________]
- ☐ Separate legal protection requires counsel review: [________________________________]
Employer representative: _____________________ Date: ______________
Intercession contact: _________________________ Date: ______________
7. CHANGE LOG
| Date | Court update | Intercession action | Employer response |
|---|---|---|---|
| [________] | [________________] | [________________] | [________________] |
| [________] | [________________] | [________________] | [________________] |
OFFICIAL SOURCE VERIFIED
About this template
- Last updated
- August 11, 2026
- Citations checked
- August 11, 2026
- Jurisdiction
- Wisconsin
- Category
- Employment & HR
Legal authority
- Wis. Stat. § 950.04(1v)(bm) (victim right to employer-intercession services for court appearances)
- Wis. Stat. § 950.04(2w)(g) (witness right to employer-intercession services for court appearances)
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 August 11, 2026.
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