So that the Order of Protection is valid, after you print, YOU MUST REPLACE THIS PAGE with the Cover Sheet: Order of Protection (available for download in PDF format) American LegalNet, Inc. www.FormsWorkFlow.com STATE OF INDIANA ) )SS: COUNTY OF ____________) IN THE __________________COURT___ (_______________DIVISION, ROOM___) CASE NO.__________________________ PLAINTIFF: ___________________________________________ DEFENDANT: _________________________________________ EMPLOYEE: __________________________________________ ORDER TO SHOW CAUSE (Workplace Violence) and Temporary Restraining Order THIS ORDER SHALL EXPIRE AT THE DATE AND TIME OF THE HEARING SHOWN IN THE BOX BELOW UNLESS EXTENDED BY THE COURT. 1. 2. To Defendant (name): ___________________________________________ YOU ARE ORDERED to appear in this court at the date, time, and place shown in the box below to give any legal reason why the order sought and the other relief requested in the petition should not be granted. Date: NOTICE OF HEARING Time: Ct. Address: _________________ Court/Room No.: ________________ 3. IT IS FURTHER ORDERED that a. Plaintiff shall serve this Order to Show Cause, the attached Petition, and any other supporting papers by (specify manner of service) __________ __________________________________________________________ no later than (date): __________________________________________ b. Any opposition/reply papers shall be filed and served on plaintiff by (specify manner of service): __________________________________________________________ no later than (date): __________________________________________ c. Proof of service of plaintiff's papers shall be delivered to the court hearing the Order to Show Cause no later than (date): ______________________ You have the right to attend the hearing to oppose the petition, with or without an attorney. If you do not attend the hearing, the court may grant the requested orders without any further notice to you. The court may make these orders enforceable TCM-WV-0102 Approved 07/02 Rev. by State Ct. Admin. 07/09 American LegalNet, Inc. www.FormsWorkFlow.com 4. Page 2 of _____ pages for a period not to exceed three (3) years, after which they may be renewed, by filing a new Petition for Injunction. You should read the instructions on page _____ of this form. A complete instruction booklet is available from the clerk's office located at the court shown above. Date: ______________________ ______________________________ JUDGE __ SIGNATURE FOLLOWS LAST ATTACHMENT INSTRUCTIONS FOR THE DEFENDANT A. If you are served with an Order to Show Cause (Workplace Violence) and a Petition of Employer for Injunction Prohibiting Violence or Threats of Violence Against Employee, you should promptly seek legal advice. If you have no attorney, the lawyer referral service of your local bar association may be of assistance. Read the papers served on you very carefully. The Order to Show Cause tells you when to appear in court and may contain a temporary restraining order forbidding you from doing certain things. If you disobey the court's orders, criminal charges may be filed against you. If you wish to oppose the Petition, or to make your own request for court orders, you should file a Response to Petition of Employer for Injunction Prohibiting Violence or Threats of Violence Against Employee. After you have filed the Response with the clerk of the court, a copy must be delivered personally or by mail to the plaintiff or the plaintiff's attorney. You cannot serve the plaintiff yourself. The person who serves the plaintiff should complete and sign a Proof of Service of Completed Response (Workplace Violence). You should take the completed form back to the court clerk or bring it with you to the hearing. If you wish to oppose the Petition, in addition to filing a Response you should be present at the hearing. If you have any witnesses, they must also be present. A complete instruction booklet entitled Instructions for Petitions to Prohibit Workplace Violence is available from the clerk's office at the court shown on this form. B. C. D. E. Page 3 of _____ pages TCM-WV-0102 Approved 07/02 Rev. by State Ct. Admin. 07/09 American LegalNet, Inc. www.FormsWorkFlow.com TEMPORARY RESTRAINING ORDER 5. THE COURT FINDS a. The defendant is (name): ______________________________________ Sex: __ Male __ Female Ht.: _____ Wt.: _____ Hair color: __________ Eye color: __________ Age: _________ Race: __________________________ Date of birth: __________________ b. c. The protected employee is (name): _______________________________ Protected family or household members who reside with employee are: (1) (Name): ______________________________________________ Sex: __ Male __ Female Date of birth: __________________________ (2) (Name): ______________________________________________ Sex: __ Male __ Female Date of birth: __________________________ (3) (Name): ______________________________________________ Sex: __ Male __ Female Date of birth: __________________________ Continued on Attachment 5c. The plaintiff has shown by reasonable proof that the employee has suffered unlawful violence or a credible threat of violence by the defendant; and plaintiff has demonstrated that great or irreparable harm has been suffered by the employee or will be suffered by the employee. d. UNTIL THE TIME OF HEARING, IT IS ORDERED 6. Defendant is prohibited from further violence or threats of violence against protected person, and SPECIFICALLY IT IS ORDERED THAT DEFENDANT a. __ shall not batter or stalk the employee and other protected persons b. __ shall not follow or stalk the employee and other protected persons to or from the place of work c. __ shall not follow the employee and other protected persons during hours of employment d. __ shall not telephone or send correspondence to the employee and other protected persons by any means including, but not limited to, the use of the public or private mails, interoffice mail, fax, or computer e-mail e. __ shall not enter the workplace of the employee and other protected persons f. __ other (specify): ____________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Page 4 of _____ pages TCM-WV-0102 Approved 07/02 Rev. by State Ct. Admin. 07/09 American Le