Model Survivor Leave Policy Template

[Employer] is committed to the health, safety, and healing of our employees and their families. If you or a family member experiences domestic violence, sexual assault, stalking, or human trafficking, we encourage you to reach out to your supervisor or the Human Resources Department about your experience to get connected with resources and support.

Our commitment includes supporting survivors of gender-based and domestic violence by providing paid and protected leave to deal with the consequences of abuse.

Any employee may take up to 4 weeks of paid and job protected time off annually when:

1. Either the employee or their family member is experiencing or has experienced domestic violence, sexual assault, stalking, or human trafficking (also referred to collectively as “abusive behavior”); and

2. The leave is being used for one or more of the below purposes relating to the abusive behavior:

  • Seek medical attention
  • Seek mental health services such as counseling or therapy
  • Secure housing / relocate
  • Obtain services from organizations or groups that serve survivors of domestic violence, sexual assault, human trafficking, and / or stalking
  • Participate in safety planning or take other actions to increase safety
  • Attend court to obtain a protective order, participate in child custody proceedings, or obtain legal or other victim services
  • Engage in advocacy efforts related to abusive behavior (e.g. participating in a demonstration, testifying at a public hearing, lobbying legislators), and / or
  • Otherwise deal with the consequences of the abusive behavior

For purposes of this policy, a “family member” includes:

1. Spouse or partner

2. Person with whom an employee is in a substantive dating or engagement relationship

3. Person with whom an employee shares a child in common

4. Parent, stepparent, child, stepchild, sibling, grandparent, or grandchild; or

5. Person in a guardianship relationship with an employee

If possible, employees should provide advance notice of their need for leave by contacting their direct supervisor or a member of the Human Resources Department. However, we understand that the experience of abusive behavior is often unpredictable and can cause an employee to miss work without prior notice. If an employee has an urgent need covered by the policy and must miss work without prior notice, the employee must contact their supervisor or a member of the Human Resources Department as soon as possible (within 3 business days of the absence), explain the circumstances, and request Survivor Leave to cover the absence retroactively.

We will not require any employee to present a police report, restraining order, or any other “proof” of the abusive behavior to be eligible for Survivor Leave.

Any information or documents that an employee shares with [Employer] in connection with this leave will remain strictly confidential except as requested by the employee, required by law, or necessary to protect the safety of the employee or others employed at [Employer].

We will not coerce, interfere with, or deny the exercise of any rights provided in this policy or make leave contingent on whether or not the survivor maintains contact with the harm-doer.

We will not terminate or discriminate against any employee for exercising their rights under this policy.

Taking leave under this policy shall not result in the loss of any employment benefit accrued prior to the commencement of the leave and upon return from an approved leave under this policy the employee shall be entitled to job restoration or an equivalent position.

The leave available under this policy is not available to an employee if they are in fact the perpetrator of the abusive behavior against their family member.

If you have any questions about this policy, please contact your direct supervisor or the Human Resources Department for more information.