Name:

Firm Name:

Address:

City:

Telephone:

Email Address:

Full Name:

Full Name:

WV-109

Notice of Court Hearing

Clerk stamps date here when form is filed.

1 Petitioner (Employer)

a. Name:

Lawyer for Petitioner (if any for this case):

State Bar No.:

b. Address (If you have a lawyer, give your lawyer’s information.):

Fill in court name and street address:

Superior Court of California, County of

State:

Fax:

Zip:

2 Employee in Need of Protection

Fill in case number:

Case Number:

3 Respondent (Person From Whom Protection Is Sought)

The court will complete the rest of this form.

4 Notice of Hearing

A court hearing is scheduled on the request for restraining orders against the respondent:

Name and address of court if different from above:

Hearing 
Date

Date:

Dept.:

Time:

Room:

5 Temporary Restraining Orders (Any orders granted are on form WV-110, served with this notice.)

a. Temporary Restraining Orders for personal conduct and stay-away orders as requested in form WV-100, 

Request for Workplace Violence Restraining Orders, are (check only one box below):

(1)

(2)

(3)

All GRANTED until the court hearing.

All DENIED until the court hearing. (Specify reasons for denial in b, below.)

Partly GRANTED and partly DENIED until the court hearing. (Specify reasons for denial in b, below.)

Judicial Council of California,  
Rev. January 1, 2023, Mandatory Form 
Code of Civil Procedure, § 527.8 
Approved by DOJ

 Notice of Court Hearing 
(Workplace Violence Prevention)

WV-109, Page 1 of 3

Case Number:

5

b. Reasons that Temporary Restraining Orders as requested in form WV-100, Petition for Workplace 

Violence Restraining Orders, for personal conduct or stay-away are denied are:

(1)

The facts as stated in form WV-100 do not sufficiently show reasonable proof that the employee 
has suffered unlawful violence or a credible threat of violence by the respondent, and that great or 
irreparable harm to the employee would result if a temporary restraining order is not issued.

(2)

Other (specify):

As stated on Attachment 5b.

6 Service of Documents by the Petitioner  

five

                                                                                                   , someone age 18 or older—not you or anyone to be 
At least                                                                                 
protected—must personally give (serve) a court file-stamped copy of this form WV-109, Notice of Court Hearing, 
to the respondent along with a copy of all the forms indicated below:

     days before the hearing

a. WV-100, Petition for Workplace Violence Restraining Orders (file-stamped)
b.
c. WV-120, Response to Petition for Workplace Violence Restraining Orders (blank form)

WV-110, Temporary Restraining Order (file-stamped) IF GRANTED

d. WV-120-INFO, How Can I Respond to a Petition for Workplace Violence Restraining Orders?

e. WV-250, Proof of Service of Response by Mail (blank form)

f.

Other  (specify):

Date:

Judicial Officer

To the Petitioner:

•  The court cannot make the restraining orders after the court hearing unless the respondent has been personally given 

(served) a copy of your request and any temporary orders. To show that the respondent has been served, the person who 
served the forms must fill out a proof of service form. Form WV-200, Proof of Personal Service, may be used.

• For information about service, read form WV-200-INFO, What Is “Proof of Personal Service”?

• If you are unable to serve the respondent in time, you may ask for more time to serve the documents. Use              

form WV-115, Request to Continue Court Hearing.

Rev. January 1, 2023

 Notice of Court Hearing 
(Workplace Violence Prevention)

WV-109, Page 2 of 3

Case Number:

To the Respondent:

• If you want to respond to the request for orders in writing, file form WV-120, Response to Request for            
Workplace Violence Restraining Orders, and have someone age 18 or older—not you or anyone to be            
protected—mail it to the petitioner.

• The person who mailed the form must fill out a proof of service form. Form WV-250, Proof of Service of         

Response by Mail, may be used. File the completed form with the court before the hearing and bring a copy with      
you to the court hearing.

•  Whether or not you respond in writing, go to the hearing if you want the judge to hear from you before making           

an  order. You may tell the judge why you agree or disagree with the orders requested.

•  You may bring witnesses and other evidence. 

•  At the hearing, the judge may make restraining orders against you that could last up to three years and may order you to 
turn in to law enforcement, or sell to or store with a licensed gun dealer, any firearms (guns) and firearm parts that you 
own or possess. This includes firearm receivers and frames, and any item that may be used as or easily turned into a 
receiver or frame (see Penal Code section 16531).

Request for Accommodations

Assistive listening systems, computer-assisted real-time captioning, or sign language  
interpreter services are available if you ask at least five days before the hearing. Contact the  
clerk’s office or go to www.courts.ca.gov/forms for Disability Accommodation Request  
(form MC-410). (Civ. Code, § 54.8.)

(Clerk will fill out this part.)

—Clerk's Certificate—

I certify that this Notice of Court Hearing is a true and correct copy of the original on file in the court. 

Clerk’s Certificate
[seal]

Date:

Clerk, by

, Deputy

Rev. January 1, 2023

 Notice of Court Hearing 
(Workplace Violence Prevention)

WV-109, Page 3 of 3