To request leave under Illinois’s Victims’ Economic Security and Safety Act, give your employer a written VESSA leave request that states your name, the dates you need off, and which qualifying purpose applies, along with a signed certification and one supporting document if your employer asks for proof.1Illinois General Assembly. Illinois Compiled Statutes 820 ILCS 180-20 Illinois does not publish a single universal form. Many employers have their own version in the handbook or HR portal, and where none exists, a written request that contains the required information satisfies the statute.2Illinois Department of Labor. Victims’ Economic Security and Safety Act (VESSA)
What to Put on the Form
Three pieces of information do the work: who you are, when you need to be off, and why the reason qualifies under VESSA.
Write down the dates. If you know you need a specific block of time, list the start and end dates. If you need leave intermittently, say so and note that you will provide specific dates as they come up. The statute allows continuous leave, intermittent leave, and reduced-schedule leave, so you do not have to force your situation into a single block.1Illinois General Assembly. Illinois Compiled Statutes 820 ILCS 180-20
State the qualifying reason. You need to be specific enough that the employer can see the request fits the statute, but you are not required to describe the violent incident itself. A single sentence works: “I am requesting leave to attend counseling related to domestic violence.” One request can cover more than one purpose if, for example, you have a medical appointment and a court hearing on the same day.
The Certification and One Supporting Document
Your employer may ask for certification that you or your family or household member is a victim and that the leave fits a qualifying reason. Certification has two parts: a signed written statement from you, plus one supporting document. You choose which document to submit from the following options:1Illinois General Assembly. Illinois Compiled Statutes 820 ILCS 180-20
- A document from a victim services organization, attorney, clergy member, or medical professional who has helped you or your family member address the violence
- A police report or court record
- Other corroborating evidence
Your employer cannot demand a particular type of document and cannot make you go get one you do not already have. If you have a police report but no medical record, the police report by itself is enough. When the leave relates to the same incident or the same perpetrator, your employer cannot require more than one supporting document during the entire 12-month period.3Legal Information Institute. Illinois Administrative Code tit. 56, 280.110 – Definitions
Submit the certification within a reasonable time after your employer requests it. The fastest route is to attach it to the leave request itself so there is no back-and-forth.
When and How to Submit It
Give at least 48 hours’ notice before the leave starts when doing so is practical.1Illinois General Assembly. Illinois Compiled Statutes 820 ILCS 180-20 The statute recognizes that safety emergencies do not always come with two days’ warning. If you have to leave suddenly, go to the emergency room, or respond to an urgent court order, notify your employer as soon as you reasonably can afterward.
How you deliver the request depends on the workplace. Some employers run leave through an HR portal or email; others accept a paper form handed to a manager. Whatever the method, save a timestamped record. An email with a read receipt, a portal confirmation screen, or a dated photo of the signed paperwork all work. That record protects you if there is later a dispute over whether you met the 48-hour window.
After you submit, expect a confirmation. If nothing comes back within a few business days, follow up in writing, and keep that follow-up too. It becomes part of your paper trail.
Which Reasons Qualify
The reason you list on the form has to fit one of the statute’s qualifying purposes. Each applies whether you are the victim or a family or household member is:1Illinois General Assembly. Illinois Compiled Statutes 820 ILCS 180-20
- Seeking medical treatment or recovering from physical or psychological injuries
- Getting help from a victim services organization
- Attending psychological or other counseling
- Making a safety plan, relocating temporarily or permanently, or taking other steps to increase safety or economic security
- Obtaining legal assistance, preparing for court, or participating in a civil, criminal, or military proceeding related to the violence
- Attending a funeral or wake, making arrangements after the death, or grieving a family or household member killed in a crime of violence
How Much Leave to Ask For
Your maximum in a 12-month period depends on your employer’s size:1Illinois General Assembly. Illinois Compiled Statutes 820 ILCS 180-20
- 50 or more employees: up to 12 workweeks
- 15 to 49 employees: up to 8 workweeks
- 1 to 14 employees: up to 4 workweeks
Employees whose family or household member was killed in a crime of violence may take up to two additional weeks for funeral arrangements, attending a wake, or grieving.4Illinois Department of Labor. File a Workplace Complaint
VESSA leave is unpaid. It does not stack on top of federal Family and Medical Leave Act time; if you qualify for both, the employer can count the same time against both entitlements at once.
What Your Employer Has to Keep Confidential
Everything you provide as part of a VESSA request stays confidential: the form, the certification, the supporting document, and the fact that you asked for leave at all.1Illinois General Assembly. Illinois Compiled Statutes 820 ILCS 180-20 Only two things unlock disclosure: your written consent, or a federal or state law that requires it, such as a subpoena. Otherwise, coworkers and supervisors without a business need to know are not entitled to any of it.
If Your Request Is Denied or You Face Retaliation
An employer cannot fire, refuse to hire, demote, harass, or otherwise punish you for taking or requesting VESSA leave, for being or being perceived as a victim, or for asking for a related accommodation.5Illinois General Assembly. Illinois Compiled Statutes 820 ILCS 180-30 If your request is denied, if the confidentiality rules are violated, or if you notice unexplained schedule changes, negative reviews, or shifts in how you are treated after submitting the form, document what happens and when.
You can file a complaint with the Illinois Department of Labor within three years of the violation. Complaints go in online, by email to DOL.LeaveRights@illinois.gov, or by mail to the Department of Labor at 115 S. LaSalle St., 37th floor, Chicago, IL 60603.4Illinois Department of Labor. File a Workplace Complaint The three-year window is generous, but evidence fades. File as soon as you know something has gone wrong.