Form WV-100 "Petition for Workplace Violence Restraining Orders" - California

What Is Form WV-100?

This is a legal form that was released by the California Superior Court - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the California Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form WV-100 by clicking the link below or browse more documents and templates provided by the California Superior Court.

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Download Form WV-100 "Petition for Workplace Violence Restraining Orders" - California

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Clerk stamps date here when form is filed.
Petition for Workplace Violence
WV-100
Restraining Orders
Read How Do I Get an Order to Prohibit Workplace Violence (form
WV-100-INFO) before completing this form. NOTE: Petitioner must
be an employer with standing to bring this action under Code of
Civil Procedure section 527.8. Also fill out Confidential CLETS
Information (form CLETS-001) with as much information as you know.
Petitioner (Employer)
1
a.
Name:
is a
corporation
sole proprietorship
Fill in court name and street address:
(specify):
Superior Court of California, County of
and is filing this suit on behalf of the employee identified in item
2
.
b.
Lawyer for Petitioner (if any for this case)
Name:
State Bar No.:
Firm Name:
Court fills in case number when form is filed.
Petitioner’s Address (If the petitioner has a lawyer, give the lawyer’s
Case Number:
information.)
c.
Address:
City:
State:
Zip:
Telephone:
Fax:
E-Mail Address:
Employee in Need of Protection
2
Full Name:
Sex:
M
F
Age:
Respondent (Person From Whom Protection Is Sought)
3
Full Name:
Age:
Address (if known):
City:
State:
Zip:
Additional Protected Persons
4
a. Are you asking for protection for any family or household members of the employee or for any other
employees at the employee’s workplace or at other workplaces of the petitioner?
Yes
No
(If yes, list them):
Full Name
Sex
Age Household Member? Relationship to Employee
Yes
No
Yes
No
Yes
No
Additional protected persons are listed in Attachment 4a.
This is not a Court Order.
WV-100,
Page 1 of 6
Judicial Council of California, www.courts.ca.gov
Petition for Workplace Violence Restraining Orders
Revised January 1, 2018, Mandatory Form
Code of Civil Procedure, §§ 527.8 and 527.9
(Workplace Violence Prevention)
Clerk stamps date here when form is filed.
Petition for Workplace Violence
WV-100
Restraining Orders
Read How Do I Get an Order to Prohibit Workplace Violence (form
WV-100-INFO) before completing this form. NOTE: Petitioner must
be an employer with standing to bring this action under Code of
Civil Procedure section 527.8. Also fill out Confidential CLETS
Information (form CLETS-001) with as much information as you know.
Petitioner (Employer)
1
a.
Name:
is a
corporation
sole proprietorship
Fill in court name and street address:
(specify):
Superior Court of California, County of
and is filing this suit on behalf of the employee identified in item
2
.
b.
Lawyer for Petitioner (if any for this case)
Name:
State Bar No.:
Firm Name:
Court fills in case number when form is filed.
Petitioner’s Address (If the petitioner has a lawyer, give the lawyer’s
Case Number:
information.)
c.
Address:
City:
State:
Zip:
Telephone:
Fax:
E-Mail Address:
Employee in Need of Protection
2
Full Name:
Sex:
M
F
Age:
Respondent (Person From Whom Protection Is Sought)
3
Full Name:
Age:
Address (if known):
City:
State:
Zip:
Additional Protected Persons
4
a. Are you asking for protection for any family or household members of the employee or for any other
employees at the employee’s workplace or at other workplaces of the petitioner?
Yes
No
(If yes, list them):
Full Name
Sex
Age Household Member? Relationship to Employee
Yes
No
Yes
No
Yes
No
Additional protected persons are listed in Attachment 4a.
This is not a Court Order.
WV-100,
Page 1 of 6
Judicial Council of California, www.courts.ca.gov
Petition for Workplace Violence Restraining Orders
Revised January 1, 2018, Mandatory Form
Code of Civil Procedure, §§ 527.8 and 527.9
(Workplace Violence Prevention)
Case Number:
b. Why do these people need protection? (Explain):
4
Response is stated in Attachment 4b.
Relationship of Employee and Respondent
5
a.
How does the employee know the respondent? (Describe):
Response is stated in Attachment 5a.
b.
Respondent
is
is not
a current employee of petitioner. (Explain any decision to retain, terminate,
Response is stated in Attachment 5b.
or otherwise discipline the respondent):
Venue
6
Why are you filing in this county? (Check all that apply):
The respondent lives in this county.
a.
The respondent has caused physical or emotional injury to the petitioner’s employee in this county.
b.
Other (specify):
c.
Other Court Cases
7
a. Has the employee or any of the persons named in
4
been involved in another court case with the respondent?
No
Yes
If yes, check each kind of case and indicate where and when each was filed:
Kind of Case
Filed in (County/State)
Year Filed Case Number (if known)
(1)
Workplace Violence
(2)
Civil Harassment
(3)
Domestic Violence
(4)
Divorce, Nullity, Legal Separation
(5)
Paternity, Parentage, Child Support
(6)
Eviction
Guardianship
(7)
(8)
Small Claims
(9)
Postsecondary School Violence
(10)
Criminal
(11)
Other (specify):
Are any restraining orders or criminal protective orders now in effect relating to the employee or any of the
b.
persons in
and the respondent?
No
Yes
4
(If yes, attach a copy if you have one.)
This is not a Court Order.
Revised January 1, 2018
WV-100,
Page 2 of 6
Petition for Workplace Violence Restraining Orders
(Workplace Violence Prevention)
Case Number:
Description of Respondent's Conduct
8
a.
Respondent has (check one or more):
Assaulted, battered, or stalked the employee
(1)
(2)
Made a credible threat of violence against the employee by making knowing or willful statements or
engaging in a course of conduct that would place a reasonable person in fear for his or her safety or the
safety of his or her immediate family.
b.
One or more of these acts (check either or both):
(1)
Took place at the employee’s workplace
Can reasonably be construed to be carried out in the future at the employee’s workplace
(2)
Address of workplace:
c. Describe what happened. (Provide details; include the dates of all incidents beginning with the most recent; tell
who did what to whom; identify any witnesses):
Response is stated in Attachment 8c.
d. Was the employee harmed or injured?
Yes
No (If yes, describe harm or injuries):
Response is stated in Attachment 8d.
e. Did the respondent use or threaten to use a gun or any other weapon?
(If yes, describe):
Yes
No
Response is stated in Attachment 8e.
This is not a Court Order.
Revised January 1, 2018
WV-100,
Page 3 of 6
Petition for Workplace Violence Restraining Orders
(Workplace Violence Prevention)
Case Number:
f.
For any of the incidents described above, did the police come?
Yes
No
I don’t know
8
If yes, did the employee or the respondent receive an Emergency Protective Order?
Yes
No
I don’t know
If yes, the order protects (check all that apply):
the respondent
one or more of the persons in
4
.
the employee
(Attach a copy of the order if you have one.)
þ
Check the orders you want
Personal Conduct Orders
9
I ask the court to order the respondent not to do any of the following things to the employee or to any person to
be protected listed in
:
4
a.
Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy
personal property of, or disturb the peace of the person.
b.
Commit acts of unlawful violence on or make threats of violence to the person.
c.
Follow or stalk the person during work hours or to or from the place of work.
d.
Contact the person, either directly or indirectly, by any means, including, but not limited to, in person, by
telephone, in writing, by public or private mail, by interoffice mail, by e-mail, by text message, by fax, or by
other electronic means.
e.
Enter the person’s workplace.
f.
Other (specify):
As stated in Attachment 9f.
The respondent will be ordered not to take any action to get the addresses or locations of any protected person
unless the court finds good cause not to make the order.
Stay-Away Order
10
a. I ask the court to order the respondent to stay at least
yards away from (check all that apply):
(1)
The employee.
(8)
The employee’s vehicle.
(2)
The other persons listed in
.
(9)
Other (specify):
4
(3)
The employee’s workplace.
(4)
The employee’s home.
(5)
The employee’s school.
(6)
The school of the employee’s
children.
(7)
The place of child care of the employee’s
children.
This is not a Court Order.
Revised January 1, 2018
WV-100,
Page 4 of 6
Petition for Workplace Violence Restraining Orders
(Workplace Violence Prevention)
Case Number:
b.
If the court orders the respondent to stay away from all the places listed above, will he or she still be able to get
10
to his or her home, school, or job?
Yes
No
(If no, explain):
Response is stated on Attachment 10b.
Guns or Other Firearms and Ammunition
11
Does the respondent own or possess any guns or other firearms?
Yes
No
I don’t know
If the judge grants a protective order, the respondent will be prohibited from owning, possessing, purchasing,
receiving, or attempting to purchase or receive a gun, other firearm, and ammunition while the protective order is
in effect. The respondent will also be ordered to turn in to law enforcement, or sell to or store with a licensed gun
dealer, any guns or firearms within his or her immediate possession or control.
Temporary Restraining Order
12
I request that a Temporary Restraining Order (TRO) be issued against the Respondent to last until the hearing. I am
presenting form WV-110, Temporary Restraining Order, for the court’s signature together with this Petition.
Has the Respondent been told that you were going to go to court to seek a TRO against him/her?
Yes
No
(If you answered no, explain why below):
Reasons are stated in Attachment 12.
Request for Less Than Five Days' Notice of Hearing
13
You must have your papers personally served on the respondent at least five days before the hearing, unless the
court orders a shorter time for service. (Form WV-200-INFO explains what is proof of personal service. Form
WV-200, Proof of Personal Service, may be used to show the court that the papers have been served.)
If you want there to be fewer than five days between service and the hearing, explain why:
Reasons are stated in Attachment 13.
No Fee for Filing
14
I ask that there be no filing fee because the respondent has threatened violence against the employee, or stalked
the employee, or acted or spoken in a manner that has placed the employee in reasonable fear of violence.
This is not a Court Order.
Revised January 1, 2018
WV-100,
Page 5 of 6
Petition for Workplace Violence Restraining Orders
(Workplace Violence Prevention)