Family and Domestic Violence Leave Request Form

What Is a Family and Domestic Violence Leave Request Form?

A Family and Domestic Violence Leave Request Form is a formal document used by employees to notify their employer they need to take leave due to circumstances involving family and domestic violence. Under the Fair Work Act 2009 (Cth), this is a legal entitlement for all employees in Australia, including full-time, part-time, and casual workers.

The form serves as a record of the request and the evidence provided. It allows the business to process payroll correctly and manage rosters, but more importantly, it initiates the support framework for the employee. For tradespeople, small business owners, and larger organisations, this document is a compliance tool. It helps the business meet its obligations under the National Employment Standards (NES) while ensuring the employee is treated with sensitivity and care during a crisis.

Unlike standard leave forms for sick leave or holidays, this document requires a specific design approach. It must collect enough information to satisfy the "reasonableness" test set out by the Fair Work Ombudsman without violating privacy laws or causing further distress to the employee.

When to Use This Document

Employers and employees should use this document whenever an employee needs to take time off work to deal with the impact of family and domestic violence. The Fair Work Act states that this leave is available to all employees, including those working casually. This means a tradie on a casual contract has the same right to paid leave as a site manager or office administrator.

You should use this form in the following scenarios:

• Attending Appointments: When the employee needs time to see a doctor, lawyer, or counsellor regarding the violence.
• Legal Proceedings: When the employee must attend court to obtain an intervention order or give evidence.
• Safety Arrangements: When the employee needs to relocate, find new housing, or arrange for their children to be moved to a safe location.
• Police Services: When the employee needs to file a report or speak with law enforcement.

The employee must give notice to the employer as soon as practicable. In many urgent situations, such as fleeing danger immediately, the notice might be given after the leave has started. The form helps document this timeline. It is also relevant when an employee needs to take leave in a single continuous block or intermittently, such as taking a few hours off for a court appointment.

Key Sections and Required Elements

To be legally compliant and practically useful, a request form must include specific elements. These sections balance the employer's need for records with the employee's right to privacy. You can find a compliant template in our HR Document Library.

Employee Details and Leave Dates

This section establishes who is taking the leave and when. It is standard for any leave request. You need to capture the employee's full name, payroll number, and job title. Crucially, you must record the specific dates and total hours of leave requested. This ensures the payroll team deducts the correct amount from the employee's accrued 10-day entitlement.

Declaration of Circumstance

This is the core part of the form. It should include a checkbox or text field where the employee confirms they are experiencing family and domestic violence. The form should list the acceptable reasons for the leave, such as attending court, seeking medical help, or making safety arrangements. This aligns with section 106 of the Fair Work Act. The form does not need the employee to write a lengthy story. A simple declaration that the leave relates to FDV is sufficient.

Evidence Attachment

The form must provide a space to indicate what evidence is attached. Under the NES, employees must provide evidence that would satisfy a reasonable person. The form should list acceptable options like a statutory declaration, medical certificate, court order, or a letter from a support service. It is best practice to include a checkbox for "Statutory Declaration" as this is often the most accessible form of evidence for victims who may not have engaged with police.

Privacy and Confidentiality Acknowledgement

Because the information on this form is sensitive, the document must contain a confidentiality statement. This section confirms that the employer will handle the data with strict care. Even small businesses with a turnover under $3 million, which are often exempt from the Privacy Act, should include this to meet their duty of care under Work Health and Safety (WHS) laws.

Support Services Disclaimer

Best practice dictates including contact details for national support services like 1800RESPECT. This shows the employee that the business provides a supportive environment. It serves as a duty of care under the Work Health and Safety Act, helping to manage psychosocial risks in the workplace.

How to Write a Family and Domestic Violence Leave Request Form (Step by Step)

Creating this form requires care. You want to make sure it is easy to use for a tradie on a job site and legally robust for HR. If you prefer not to start from scratch, you can use a pre-made Family and Domestic Violence Leave Template. If you are writing one yourself, follow these steps.

Step 1: Define the Scope and Entitlement

Start with a clear statement at the top of the form. It should reference the Fair Work Act 2009 (Cth) and confirm that the employee is entitled to 10 days of paid leave per year. This sets the legal context immediately. It clarifies that the form is for the purpose of accessing this specific entitlement.

Step 2: Create the Employee Declaration

Draft a section where the employee enters their details and leave dates. Below this, add a declaration sentence. It should read something like: "I declare that I need to take leave to deal with the impact of family and domestic violence." Avoid asking the employee to describe the violence. Do not ask who the perpetrator is. This information is not necessary for approving the leave and can deter someone from seeking help.

Step 3: List Acceptable Evidence

Create a checklist for evidence. This guides the employee on what they can provide. Include options for:

• A document issued by the police service.
• A document issued by a court.
• A statutory declaration.
• A medical certificate.
• A letter from a registered health professional or a family violence support service.

Adding a note that "other evidence" can be submitted ensures you remain flexible. This aligns with the Fair Work Ombudsman's guidance on reasonableness.

Step 4: Add Confidentiality Clauses

Write a clear statement about who will see this form. State that it will be kept in a secure file, separate from the general personnel file if possible. Specify that only necessary staff, such as a payroll officer or direct manager, will access it. This is vital for maintaining trust and ensuring the safety of the employee.

Step 5: Include WHS and Safety Information

Add a section asking if the employee requires any workplace safety measures. This is a requirement under WHS regulations. For example, if the perpetrator works nearby or knows the work location, the business may need to change the employee's work site or phone number. A simple checkbox asking "Do you require any safety changes at work?" can prompt a vital conversation.

Step 6: Review Against Anti-Discrimination Laws

Before finalising the form, check that the language does not discriminate. Ensure the form is inclusive of all genders and relationship types. The Sex Discrimination Act 1984 prohibits discrimination on the basis of family responsibilities. The form should not imply that only women can be victims or that the violence must be physical.

Common Mistakes to Avoid

Businesses often unintentionally create barriers for employees when drafting these forms. Avoiding these mistakes ensures you comply with the Fair Work Act and protect your business from legal risks.

Requesting Excessive Detail

One of the most common errors is asking the employee to describe the incident of violence on the form. This is a breach of privacy and can cause significant psychological distress. The "reasonableness" test for evidence only requires proof that the violence occurred and that the leave is necessary. It does not require the specific details. Do not include a text box asking for the "nature of the injury" or "details of the incident."

Restricting Evidence Types

Some forms state that only a police report is acceptable. This is incorrect. Many victims of domestic violence do not report the crime to police due to fear or safety concerns. Restricting evidence to police reports may be seen as unreasonable and could lead to a dispute. Always accept statutory declarations and letters from support workers as valid proof.

Forgetting Casual Employees

Do not create a form that implies only permanent staff are eligible. Since February 2023, casual employees have been entitled to 10 days of paid FDV leave. If your form asks for "annual leave balance" or assumes an ongoing roster, it might confuse casual staff who work irregular hours. Ensure the wording covers all employment types.

Failing to Secure the Data

Leaving these forms in a communal inbox or on a shared desk is a major risk. If the wrong person reads this form, it could put the employee in danger. Even if you are a small business exempt from the Privacy Act, you have a duty of care under WHS laws to protect workers from risks. Ensure the completed form is stored securely, ideally in a locked cabinet or a password-protected digital folder.

Ignoring State Variations

While the NES provides a baseline, some states have specific guidelines regarding WHS and support. For example, Victoria has specific Occupational Health and Safety Act duties regarding psychosocial hazards. Ensure your form does not contradict these state-based obligations. It is safer to adopt a "best practice" approach that meets the highest standard across all jurisdictions.

Legal Considerations (AU)

When managing family and domestic violence leave, you must navigate several areas of Australian law. Understanding these helps you manage the process correctly and supports your staff.

Fair Work Act 2009 (Cth)

The Fair Work Act is the primary legislation governing this leave. The National Employment Standards (NES) grant all employees 10 days of paid family and domestic violence leave each year. This leave accumulates from year to year if it is not used. Unlike personal leave, it does not require a medical certificate specifically, but it does require "evidence that would satisfy a reasonable person." The Act also prohibits adverse action. You cannot fire, demote, or injure an employee because they have taken this leave. Using a standardised Leave Request Form helps ensure you treat all requests consistently and fairly.

Privacy Act 1988

The information an employee provides on an FDV leave form is classified as "sensitive information" under the Privacy Act. While small businesses with a turnover of less than $3 million are generally exempt from the Act, complying with its principles is best practice. This means you must only collect information that is necessary, keep it secure, and only use it for the intended purpose. Sharing this information with colleagues who do not need to know could be a breach of privacy and a safety risk.

Work Health and Safety (WHS)

Under model WHS laws adopted in most states and territories, a Person Conducting a Business or Undertaking (PCBU) has a primary duty of care. This includes ensuring the health and safety of workers so far as is reasonably practicable. Family and domestic violence is a recognised psychosocial hazard. If the violence enters the workplace, or if the employee is stressed and unsafe at home, this affects their ability to work safely. The leave request form is often the first step in identifying these risks so you can implement controls, such as changing work patterns or locations.

Anti-Discrimination Law

The Sex Discrimination Act 1984 and the Fair Work Act protect employees from discrimination. Denying a legitimate request for FDV leave because of the employee's gender or because you do not believe them could lead to a discrimination claim. It is important to assess every request based on the evidence provided, without bias. If you are unsure about the validity of a request, seek advice from the Fair Work Ombudsman or an employment lawyer rather than rejecting it outright.

Frequently Asked Questions (preview)

Do casual employees get paid for this leave? Yes. All employees in Australia, including casuals, are entitled to 10 days of paid family and domestic violence leave per year under the NES. They are paid at their full base pay rate for the hours they would have worked.

What can I use as evidence if I don't have a police report? You can provide a statutory declaration, a medical certificate, or a letter from a support service. A statutory declaration is often the easiest option. It is a signed statement declaring the truth of the content, witnessed by an authorised person.

Can I ask the employee for details about the violence? No. You should only ask for information that is necessary to manage the leave and ensure workplace safety. Asking for details of the violence is intrusive and not required by law.

Does the leave accrue like annual leave? Yes. The 10 days of leave accrues at the start of each year of service. If an employee does not use the full 10 days, the unused leave carries over to the next year.

Is this form confidential? Yes, it must be treated as highly sensitive. The information should only be shared with people who need to know to approve the leave or manage safety risks. You should not discuss it with other staff members.