How to Fill Out Form EPO-001

Form EPO-001 at a glance

What it is: Form EPO-001 is the Emergency Protective Order (CLETS-EPO) for Domestic Violence, Child Abuse, Elder or Dependent Adult Abuse, or Stalking.

Where and when to file: A copy must be filed with the court as soon as practicable.

A filled-in Form EPO-001 example: an officer fills out an emergency protective order

Form EPO-001 example filled out, example: an officer fills out an emergency protective order
Officer Dana Sample fills out Form EPO-001 for a protected person. A judge grants an emergency order after a threat, and the restrained person must stay 100 yards away. The picture shows page 1 only, and all its values are invented. Judge Alex Example granted the order on Monday, March 2, 2026 at 3:00 PM, so it expires at 5:00 PM on Monday, March 9, 2026, the 5th court day and the 7th calendar day. Jordan Sample is female, and Casey Example, born January 15, 1992, is a 34 year old male with brown hair and eyes. Casey Example threatened Jordan with a handgun on March 1, 2026, and the officer saw it, so observed is ticked in item 10. Item 4 is left blank because no child is given care, item 11 is left blank because the two do not live together, and item 12 is left blank because they have no children in common. The second stay away line and move out in item 3c stay empty because the order names only the person, and the proof of service stays empty because the order is not yet served.

How to fill out Form EPO-001, box by box

LAW ENFORCEMENT CASE NUMBER and ONE copy to court

Form EPO-001 example filled out, lAW ENFORCEMENT CASE NUMBER and ONE copy to court

Enter the LAW ENFORCEMENT CASE NUMBER. Print ONE copy to court, ONE copy to restrained person, ONE copy to protected person, ONE copy to issuing agency.

1. PROTECTED PERSONS

Form EPO-001 example filled out, 1. PROTECTED PERSONS

Enter the name and gender (M, F, X) of all people protected by this order.

2. RESTRAINED PERSON

Form EPO-001 example filled out, 2. RESTRAINED PERSON

Under RESTRAINED PERSON, enter the Name, Race, Age, Date of birth, Ht., Wt., Hair color and Eye color, and check the Gender: M F X.

3. TO THE RESTRAINED PERSON: YOU MUST NOT harass or contact

Form EPO-001 example filled out, 3. TO THE RESTRAINED PERSON: YOU MUST NOT harass or contact

TO THE RESTRAINED PERSON: check a. for YOU MUST NOT harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property of, keep under surveillance, impersonate, block movements of, annoy by phone or other electronic means (including repeatedly contact), or disturb the peace of (including coercive control), any person named in item 1. Check b. for YOU MUST NOT contact, either directly or indirectly, by any means, including but not limited to by telephone, mail, email or other electronic means, any person named in item 1.

3c. YOU MUST stay away or move out

Form EPO-001 example filled out, 3c. YOU MUST stay away or move out

Check c. for YOU MUST stay away at least: yards from each person named in item 1. Enter the yards for each stay away at least line, and under move out immediately from enter the (address).

4. Temporary care and control of the minor children

Form EPO-001 example filled out, 4. Temporary care and control of the minor children

Enter the (Name) who is given temporary care and control of the minor children of the parties, and enter their names and ages.

5. Order Expires on (date), and 6. To Person in 1 (Name and address of court)

Form EPO-001 example filled out, 5. Order Expires on (date), and 6. To Person in 1 (Name and address of court)

Enter the (date) and (time) the order expires on. The order expires on the 5th court day or 7th calendar day, whichever is earlier. Do not count the day the order is granted. To Person in 1: To ask for a longer restraining order, ask for help at your local court. If there is an open juvenile case, file in that case. Enter the Name and address of court.

8. Judicial officer

Form EPO-001 example filled out, 8. Judicial officer

Enter the Judicial officer (name) who granted this Order, and the (date) and (time) it was granted.

9. The events that caused the protected person to fear danger

Form EPO-001 example filled out, 9. The events that caused the protected person to fear danger

Give facts and dates, and specify weapons, of the events that caused the protected person to fear immediate and present danger of domestic violence, child abuse, child abduction, elder or dependent adult abuse (except solely financial abuse), or stalking.

10. Firearms or ammunition

Form EPO-001 example filled out, 10. Firearms or ammunition

Firearms or ammunition were (check all that apply): observed, reported, physically searched for, seized.

11. The persons in 1 and 2 live together

Form EPO-001 example filled out, 11. The persons in 1 and 2 live together

Check box 11 for: The persons in 1 and 2 live together. The person in 1 asks that the person in 2 immediately move out from the address in 3c.

12. The person in 1 has minor children in common with the person in 2

Form EPO-001 example filled out, 12. The person in 1 has minor children in common with the person in 2

Check box 12 for: The person in 1 has minor children in common with the person in 2, and a temporary custody order is requested because of the facts alleged in item 9. Check does exist or does not exist for a custody order.

PRINT NAME OF LAW ENFORCEMENT OFFICER, Agency, Telephone No. and Badge No.

Form EPO-001 example filled out, pRINT NAME OF LAW ENFORCEMENT OFFICER, Agency, Telephone No. and Badge No.

Enter the (PRINT NAME OF LAW ENFORCEMENT OFFICER), the Agency, the Telephone No. and the Badge No., and sign the (SIGNATURE OF LAW ENFORCEMENT OFFICER) line.

13. PROOF OF SERVICE

Form EPO-001 example filled out, 13. PROOF OF SERVICE

Under PROOF OF SERVICE, enter the (date) and (time) you personally delivered (served) copies of this Order to the person in 2, and the Address where person in 2 was served.

14. At the time of service

Form EPO-001 example filled out, 14. At the time of service

At the time of service, I was at least 18 years of age and not a party to this cause. Check the box: I am a California law enforcement officer. Enter the address and telephone number (this does not have to be server's home telephone number or address).

I declare under penalty of perjury under the laws of the State of California that this is true and correct.

Enter the (TYPE OR PRINT NAME OF SERVER) and the Date, and sign the (SIGNATURE OF SERVER) line.

More rules for Form EPO-001

Reasonable grounds for the issuance of this Order exist, and an emergency protective order is necessary to prevent the occurrence or recurrence of domestic violence, child abuse, child abduction, elder or dependent adult abuse, or stalking.

If your situation is different

Firearms, firearm parts, ammunition and body armor

YOU MUST NOT take any action, directly or through others, to obtain the addresses or locations of any person named in item 1. YOU MUST NOT own, possess, purchase, receive, or attempt to purchase or receive any firearm (guns), firearm parts (receiver, frame or item that may be used as or easily turned into a receiver or frame), or ammunition. You must immediately surrender these items if asked by law enforcement. If not asked by law enforcement to surrender immediately, you must turn them in to a law enforcement agency or sell them to, or store them with, a licensed gun dealer within 24 hours of receiving this order.

After you have turned in or sold your items, you must file a receipt with the court that proves that all items listed in 3e have been turned in or sold.

YOU MUST NOT own, possess, or buy body armor. You must relinquish any body armor that you have in your possession.

To the restrained person: follow this order

To the restrained person: You must follow this order until it expires (see item 5).

If you violate the order, you can be arrested, charged with a crime, and/or fined.

If you are served with another restraining order, you must follow the order.

To the protected person: the order will expire

To the protected person: This order will expire on the the date and time listed in item 5.

If you want a longer restraining order to protect you or your children from abuse, you will have to ask for one from your local court.

Start the process as soon as you can.

The paperwork can take a few hours to complete.

There is no court fee and you do not need a lawyer to ask for one, but the process can be hard to get through on your own.

Free help may be available at your local court's self-help center.

To Law Enforcement: serve this order

To Law Enforcement: This order must be served on the restrained person by the officer, if the restrained person can be found.

A copy must be given to the protected person.

Also, the officer must have the order entered into CLETS (CARPOS).

This emergency protective order is effective when made and must be enforced by all law enforcement officers in the State of California who are aware of or shown a copy of this order.

The terms and conditions of this order are enforceable regardless of the acts of the parties; the order may be changed only by the court (Penal Code section 13710(b)).

The availability of an emergency protective order must not be affected by the fact that the endangered person has vacated the household to avoid abuse.

Sources

[1] Form EPO-001 (Rev. January 1, 2025), Emergency Protective Order (CLETS-EPO), Judicial Council of California (the Official source link on this page).

EPO-001 PDF Details

To law enforcement: this order must be served on the restrained person by the officer, if the restrained person can be found.

Order expires: do not count the day the order is granted.

Firearms: restrained persons must surrender them immediately if asked by law enforcement; if not, turn them in to law enforcement or licensed gun dealers within 24 hours.

Receipt: after the items are turned in or sold, a receipt must be filed with the court that proves that all items listed in 3e have been turned in or sold.

Longer order: to ask for a longer restraining order, ask for help at your local court; if there is an open juvenile case, file in that case.

Copy: one copy to court, one copy to restrained person, one copy to protected person, one copy to issuing agency.

QuestionAnswer
Form NameEPO-001
Form Length2 pages
Fillable?Yes
Fillable fields109
Avg. time to fill out19 min
EditionJanuary 1, 2025
Issuing agencyJudicial Council of California
Who signsA law enforcement officer
Matches the agency's fileYes, checked October 1, 2026
Other namesEPO-001, EPO001, EPO 001, California EPO-001, Emergency Protective Order
Official sourceEPO-001 (Rev January 1, 2025), Judicial Council of California