California Form Wv 100 PDF Details

The California WV-100 form, officially recognized as the Petition for Workplace Violence Restraining Orders, plays a pivotal role in enhancing safety within the workplace by enabling employers to take legal action aimed at preventing violence and ensuring protection for their employees. Designed within the legal framework established by Code of Civil Procedure sections 527.8 and 527.9, this form must be completed by an employer, who can be a corporation or a sole proprietorship, seeking to restrain individuals who may pose a threat to the workplace environment. Its comprehensive structure allows employers to not only request restraining orders against the person in question but also extend protection to other employees and family members who may be at risk. The form necessitates detailed information about the parties involved, including the employer (petitioner), the employee in need of protection, and the respondent from whom protection is sought. It requires a thorough description of the respondent's conduct, evidence of the threat or harm already inflicted, and the specific types of restraining orders being sought, such as personal conduct orders and stay-away orders. Additionally, the form includes provisions for addressing the respondent's possession of firearms and the issuance of temporary restraining orders (TROs) pending a full court hearing. By filling out this form, employers align with California's strong stance on preventing workplace violence, demonstrating a proactive approach to maintain a safe and secure work environment for all.

QuestionAnswer
Form NameCalifornia Form Wv 100
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namescalifornia petition workplace violence, 100 wv, workplace form, form wv restraining

Form Preview Example

 

Petition for Workplace Violence

Clerk stamps date here when form is filed.

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.

1Petitioner (Employer) a. Name:

is a

corporation

sole proprietorship

(specify):

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:

 

 

 

 

 

 

 

 

 

Fill in court name and street address:

Superior Court of California, County of

Court fills in case number when form is filed.

Petitioner’s Address (If the petitioner has a lawyer, give the lawyer’s information.)

c. Address:

City:

State:

 

Zip:

 

 

 

 

 

 

 

 

 

 

Telephone:

Fax:

 

 

 

 

 

 

 

 

 

 

 

 

E-Mail Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Case Number:

2Employee in Need of Protection

Full Name:

Sex: M

F

Age:

3Respondent (Person From Whom Protection Is Sought)

Full Name:

 

 

 

 

Age:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address (if known):

 

 

 

 

 

 

 

 

 

City:

 

State:

 

Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4Additional Protected Persons

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 Yes

✖

✖

No

No

Additional protected persons are listed in Attachment 4a.

This is not a Court Order.

Judicial Council of California, www.courts.ca.gov Revised January 1, 2018, Mandatory Form Code of Civil Procedure, §§ 527.8 and 527.9

Petition for Workplace Violence Restraining Orders

WV-100, Page 1 of 6

 

(Workplace Violence Prevention)

Case Number:

4b. Why do these people need protection? (Explain):

Response is stated in Attachment 4b.

5Relationship of Employee and Respondent

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,

 

or otherwise discipline the respondent):

Response is stated in Attachment 5b.

 

 

 

 

 

 

 

 

 

 

6Venue

Why are you filing in this county? (Check all that apply):

a. The respondent lives in this county.

b. The respondent has caused physical or emotional injury to the petitioner’s employee in this county.

c. Other (specify):

7Other Court Cases

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

(7) Guardianship

(8) Small Claims

(9) Postsecondary School Violence

(10) Criminal

(11) Other (specify):

b. Are any restraining orders or criminal protective orders now in effect relating to the employee or any of the

persons in 4 and the respondent?

No

Yes (If yes, attach a copy if you have one.)

This is not a Court Order.

Revised January 1, 2018

Petition for Workplace Violence Restraining Orders

WV-100, Page 2 of 6

(Workplace Violence Prevention)

Case Number:

8Description of Respondent's Conduct

a.Respondent has (check one or more):

(1) Assaulted, battered, or stalked the employee

(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

(2)

Can reasonably be construed to be carried out in the future at the employee’s workplace

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?

Yes

Response is stated in Attachment 8e.

 

✖

No (If yes, describe):

This is not a Court Order.

Revised January 1, 2018

Petition for Workplace Violence Restraining Orders

WV-100, Page 3 of 6

(Workplace Violence Prevention)

Case Number:

8 f. For any of the incidents described above, did the police come?

Yes

✖

No

I don’t know

 

 

 

 

 

 

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 employee

the respondent

one or more of the persons in

4 .

(Attach a copy of the order if you have one.)

 

 

 

 

 

Check the orders you want

9 Personal Conduct Orders

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.

10Stay-Away Order

a. I ask the court to order the respondent to stay at least

 

yards away from (check all that apply):

(1)

(2)

(3)

(4)

(5)

(6)

(7)

The employee.

(8)

The employee’s vehicle.

The other persons listed in 4 .

(9)

Other (specify):

The employee’s workplace.

The employee’s home.

The employee’s school.

The school of the employee’s children.

The place of child care of the employee’s children.

This is not a Court Order.

Revised January 1, 2018

Petition for Workplace Violence Restraining Orders

WV-100, Page 4 of 6

(Workplace Violence Prevention)

Case Number:

10b. If the court orders the respondent to stay away from all the places listed above, will he or she still be able to get

to his or her home, school, or job?

Yes ✖ No

(If no, explain):

Response is stated on Attachment 10b.

 

 

 

 

 

 

 

 

11Guns or Other Firearms and Ammunition

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.

12 Temporary Restraining Order

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.

13 Request for Less Than Five Days' Notice of Hearing

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.

14 No Fee for Filing

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

Petition for Workplace Violence Restraining Orders

WV-100, Page 5 of 6

(Workplace Violence Prevention)

Case Number:

15

16

17

18

No Fee to Serve Orders

I ask the court to order the sheriff or marshal to serve the respondent with the others for free because this request for orders is based on a credible threat of violence or stalking.

Court Costs

I ask the court to order the respondent to pay my court costs.

Additional Orders Requested

I ask the court to make the following additional orders (specify):

Additional orders requested are stated in Attachment 17.

Number of pages attached to this form, if any:

Date:

Lawyer’s name (if any)

 

Lawyer’s signature

I declare under penalty of perjury under the laws of the State of California that the information above and on all attachments is true and correct.

Date:

Name of petitioner

 

Signature

Title

This is not a Court Order.

Revised January 1, 2018

Petition for Workplace Violence Restraining Orders

WV-100, Page 6 of 6

(Workplace Violence Prevention)

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The best way to fill out california violence form stage 1

2. Once this selection of fields is done, go to type in the applicable information in all these: Sex, Age, Respondent Person From Whom, Full Name, Address if known, City, Additional Protected Persons, Age, State, Zip, a Are you asking for protection, employees at the employees, Yes, If yes list them, and Full Name.

Part no. 2 of submitting california violence form

3. The following segment is about b Why do these people need, Response is stated in Attachment b, Relationship of Employee and, How does the employee know the, Response is stated in Attachment a, Respondent a current employee of, Response is stated in Attachment b, is not, Venue Why are you filing in this, The respondent lives in this county, and The respondent has caused physical - type in these empty form fields.

Completing part 3 of california violence form

4. Filling out The respondent has caused physical, Other Court Cases, a Has the employee or any of the, Yes, If yes check each kind of case and, Kind of Case, Filed in CountyState, Year Filed Case Number if known, Workplace Violence Civil, Divorce Nullity Legal Separation, Paternity Parentage Child Support, Eviction, Guardianship, Small Claims, and Postsecondary School Violence is paramount in this fourth stage - make certain that you be patient and fill out each blank area!

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Always be extremely attentive while filling out Yes and Paternity Parentage Child Support, since this is the part where most people make mistakes.

5. This final section to conclude this PDF form is critical. Be sure to fill in the necessary blank fields, which includes Are any restraining orders or, If yes attach a copy if you have, Yes, Revised January , Petition for Workplace Violence, WV Page of , Workplace Violence Prevention, and This is not a Court Order, before finalizing. Neglecting to do so can contribute to a flawed and potentially unacceptable form!

Guidelines on how to fill out california violence form stage 5

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