1 2 Case No. _____________________ Dept. No._____________________ 3 IN THE JUSTICE COURT OF _____________ TOWNSHIP 4 COUNTY OF __________________, STATE OF NEVADA 5 _____________________________________, ) Employer,) ) 7 ) ) vs. 8 ) ) 9 _____________________________________. ) Adverse Party. 6 10 EXTENDED ORDER FOR PROTECTION AGAINST HARASSMENT IN THE WORKPLACE (NRS 33.270) Date Issued: _____________ Time: _____ __. m. Expiration Date: __________ Time: 11:59 p.m. 11 12 13 14 15 16 17 18 19 20 WARNING: This is an official Court Order. If you disobey this Order, you may be arrested and prosecuted for the crime of violating an Order for Protection Against Harassment in the Workplace and any other crime that you may have committed in disobeying this Order. An intentional violation of an Extended Order for Protection Against Harassment in the Workplace is a misdemeanor, unless a more severe penalty is prescribed by law for the act that constitutes the violation of the Order. Under NRS 193.150, a misdemeanor is punishable by imprisonment in the county jail for not more than 6 months, or by a fine of not more than $1,000.00, or by both fine and imprisonment. PURSUANT TO NRS 193.166, if the act that constitutes the violation of a protection order is itself a felony, the violator shall, in addition to the term of imprisonment prescribed by statute for the crime, be punished by imprisonment in the state prison for a minimum term of not less than 1 year and a maximum term of not more than 20 years. YOU ARE FURTHER NOTIFIED that YOU CAN BE ARRESTED even if the person who obtained the Order invites or allows you to contact them. You have the sole responsibility to avoid or refrain from violating the terms of this Order. Only the Court can change the Order upon written application. 21 22 23 24 25 The Court having considered the filings, testimony (if applicable) and evidence presented at hearing, and the Court having found that the Adverse Party received notice of hearing at which such person had an opportunity to participate and be heard, and the Adverse ͕ was present, ͕ was not present, ͕ was represented by counsel______________ ______________________________________and the Applicant ͕was present, ͕was not Party Form B-25 Extended Order for Protection Against Harassment in the Workplace Page 1 of 4 ©2007 Nevada Supreme Court Revised July 27, 2007 1 present, [ ] was represented by counsel ____________________________, and the Court 2 having proper jurisdiction over the parties and this subject matter, and it appearing to the 3 satisfaction of the Court that the Adverse Party has committed and/or is committing or 4 remains a threat to commit harassment in the workplace and good cause appearing, 5 6 7 8 9 10 IT IS HEREBY ORDERED that the Extended Order for Protection Against Harassment in the Workplace is granted for the following reasons: The Court has found that the employer has presented evidence sufficient to support the granting of the application for an Extended Order of Protection Against Harassment in the Workplace; and The Court has found that the Adverse Party knowingly threatened to cause or committed an act causing bodily injury to himself or another person; and/or damage to the 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 property of another person; and/or substantial harm to the physical or mental health or safety of a person. Other: ______________________________________________________________ IT IS FURTHER ORDERED that you, the Adverse Party, are prohibited, either directly or through an agent, from contacting, intimidating, using, attempting to use, or threatening the use of physical force, or otherwise interfering in any way with the employer, any employee of the employer while the employee is performing his duties of employment, and any person while the person is present at the workplace of the employer, including, but not limited to, in person, by telephone, through the mail, through electronic mail (e-mail), facsimile (fax), or through another person. IT IS FURTHER ORDERED that you stay away from the workplace of the employer, wherever situated within the State, including, but not limited to, the following specific workplace address(es): _________________________________________________ Town/City of __________________, County of ________________, State of _____________ Other: _____________________________________________________________________ Form B-25 Extended Order for Protection Against Harassment in the Workplace Page 2 of 4 ©2007 Nevada Supreme Court Revised July 27, 2007 1 IT IS FURTHER ORDERED that the following additional restrictions apply: 2 ___________________________________________________________________________ 3 ___________________________________________________________________________ 4 ___________________________________________________________________________ 5 ___________________________________________________________________________ 6 ___________________________________________________________________________ 7 ___________________________________________________________________________ 8 ___________________________________________________________________________ 9 ___________________________________________________________________________ 10 IT IS FURTHER ORDERED that the Clerk of the Court shall transmit, by the end 11 of the next business day after this Extended Order is issued, a copy of the Order, together with 12 a copy of the Application, to the following law enforcement agencies: 13 ___________________________________________________________________________ 14 ___________________________________________________________________________ 15 ___________________________________________________________________________ 16 ___________________________________________________________________________ 17 ___________________________________________________________________________ 18 IT IS FURTHER ORDERED that the appropriate law enforcement agency/process 19 server promptly attempt to serve this Order upon the Adverse Party, and to file with or mail to 20 the Clerk of the Court proof of service by the end of the next business day after service is 21 made. Service must be made pursuant to the Rules of Civil Procedure. 22 23 NOTICE TO LAW ENFORCEMENT Any law enforcement officer, with or without a warrant, and whether or not a 24 violation occurs in the presence of the officer, may arrest and take into custody the 25 Adverse Party, when the law enforcement officer has probable cause to believe that (a) Form B-25 Extended Order for Protection Against Harassment in the Workplace Page 3 of 4 ©2007 Nevada Supreme Court Revised July 27, 2007 1 an Order has been issued pursuant to NRS 33.270 against the Adverse Party; (b) the 2 Adverse Party has been served with a copy of the Order; and (c) the Adverse Party is 3 acting or has acted in violation of the Order. 4 5 Any law enforcement agency in Nevada may enforce a Court Order issued pursuant to NRS 33.270 without regard to the county in which the Order was issued. 6 If a law enforcement officer cannot verify that the Adverse Party was served with 7 a copy of this Order, the officer shall serve the Adverse Party with a copy of the Order if 8 a copy is available. 9 IT IS SO ORDERED this ________ day of ________________________, 20___. 10 11 12 13 ___________________________________________ JUDGE 14 15 16 17 18 19 20 PROOF OF SERVICE UPON ADVERSE PARTY I, the undersigned, personally served the Adverse Party named above with a copy of this Extended Order for Protection Against Harassment in the Workplace. ___________________________________________ Signature ___________________________________________ Print Name 21 22 23 24 ___________________________________________ Date of Service ___________________________________________ Time of Service 25 Form B-25 Extended Order for Protection Against Harassment in the Workplace Page 4 of 4 ©2007 Nevada Supreme Court Revised July 27, 2007