Fill out workplace violence restraining order forms

The first step in getting a workplace violence restraining order is for the employer to complete a set of court forms that will include statements about the stalking, threats, or violence the employee has experienced, as well as the protection that is being asked for. Filling out the forms usually takes one to several hours for most people.

Before you start

The judge will need details about why a restraining order is needed. If you are a sole proprietor who did not personally witness the violence, stalking, or threats, or if your business is a corporation, you must include a declaration (statement) by the employee or employees who experienced or witnessed the violence, threats, or stalking. 

Do I need a lawyer?
  • If you are the employer and have a registered legal entity for your business, such as a corporation (including a non-profit corporation) or an LLC, a lawyer must represent your business in this case.
  • If you have a sole proprietorship (you are the only owner of an incorporated business), you may hire a lawyer or represent yourself.
  • If you are the employee, you do not need a lawyer. You may be asked to testify in this case and can be a person who is protected by the restraining order. If you have questions about restraining orders or need protection outside the workplace, you can get information from your local Self-Help Center.


Request a workplace violence restraining order

You will need to fill out at least four forms to ask for a restraining order. 

Forms will not save automatically. To save a form (so you can work on it later), download the form by clicking on the upper right-hand corner, save to a computer that you can safely use, and open the saved form.
  • Fill out all required forms



    1. Petition for Workplace Violence Restraining Orders (form WV-100)

     Use this form to tell the judge:  

    • Why a restraining order is needed (what the person did to the employee or employees)

    • People and places that should be protected

    • If protection is needed right away (if so, check form WV-100, item 12)

    Note: If the person you want a restraining order against has been violent, threatened violence against, or stalked the employee or employees or has created a reasonable fear of violence, you will not have to pay the court filing fee. To make this request, check item 14 on form WV-100

    This section is important because the judge will decide whether to grant a restraining order based on statements you make in this section. On form WV-100, in item 8, explain how the person you are asking for protection from has threatened violence or been violent towards or stalked your employee or employees. You should also write about whether the employee or employees are in danger of future violence if a restraining order isn't granted.

    If you did not personally observe the violence, threats, or stalking, you must have the employee or employees who experienced the violence, threats, or stalking fill out a declaration (statement) on form MC-030 and attach it your forms. In their declaration, the employee can start with the most recent incident, even if it is not the worst incident. They can write down the facts of what happened, and include information about how the incident is connected to the workplace. They should give as much detail as they can, and be sure to sign the declaration. The judge needs facts to make a decision. If there is proof of the abuse (like an email or a text message), you can include it with your request. 

    Once you or the employees are finished writing about the most recent event, you can write about other incidents. If there has been more than one incident, be sure to write down how long the violence, threats, or stalking has been going on, how often it has happened, and any physical or emotional harm it has caused. If you need more space to write, you can use form MC-025.

    What if I don't have exact dates?

    If you or the employees don't remember the exact day something happened, give an estimate and write down that it is an estimate. To help you remember, think about whether the incident happened around a holiday or special occasion.


    2. Confidential CLETS Information (form CLETS-001)

    The information on this form will help police enforce the restraining order. The court will not use the information on this form and the person you are asking for a restraining order against will not get a copy. Some information is mandatory and is marked with an asterisk (*). You may not have all the other information about the restrained person. Fill in as much as you can.

    3. Notice of Court Hearing (form WV-109

    The court will complete most of this form. You only need to complete items 1, 2, and 3. 

    4. Temporary Restraining Order (form WV-110)

    You need this form if you are asking for protection right away (if you checked form WV-100, item 12). The court will complete most of this form. You only need to complete items 1, 2, 3, and 4.

  • Fill out optional forms

    Ask for no fees in your case

    To ask for this kind of restraining order, you may have to pay the court $435-$450.

    If you are alleging violence, threats of violence, or stalking, or if you can't afford the fees, you will not have to pay a filing fee. Learn more

    If the court grants you one of these, you will not have to pay court fees:

    1. The other person has been violent against or threatened violence against the employee, stalked the employee, or done something to make the employee afraid of violence. Write down the details on form WV-100 and be sure to check the boxes next to items 14 and 15. You will not have to pay a fee to file your papers or have the sheriff serve them if, based on the statements in your papers, the judge agrees that your case involves violence, stalking, or threats of violence.
    2. You can’t afford the fees. You qualify for a fee waiver if you have a low-income, receive public benefits, or you can't afford the fee and meet your basic needs. You will need to fill out two extra forms:
    What if I don't qualify for a fee waiver?
    You will have to pay court fees (starting at $435) when you turn in your papers unless the  judge agrees that your case involves violence, stalking, or threats of violence. 
  • Check to see if you have any local forms to complete

    Some county courts have additional local forms they require you to use. The most common local form will have questions about whether you told the other side that you are asking for a restraining order. Contact your court's free Self-Help Center, or the court clerk’s office, to see if they have any local forms you need to use. You can find your local court at Find My Court.


  • Make two copies of all your forms

    After you’ve completed and signed all your forms, make two copies. You'll need the two copies, plus the original, when you file with the court.

File Your Request

What's Next

Once you’ve completed the forms and made copies, you’ll file them with the court. 

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