Get Csudh Physicians Ada Job Accommodation Request Disability Verification 2021-2025

This guide will assist users in completing the CSUDH Physicians ADA Job Accommodation Request Disability Verification form online. The form is essential for determining whether an employee qualifies for reasonable accommodations under the Americans with Disabilities Act.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the patient or employee in the designated field at the top of the form.
3. Enter the date of the request in the provided date field.
4. Review the questions regarding the patient's or employee's disability status carefully. Ensure that you provide accurate answers to the three main questions presented, indicating 'yes' or 'no' as appropriate.
5. For the next section, assess whether the impairment is permanent. If not, indicate the duration by filling in the number of days, weeks, months, or years the impairment is expected to last.
6. Next, answer if the impairment substantially limits a major life activity by selecting 'yes' or 'no'. If 'yes', specify which major life activities are affected from the list provided.
7. Continue by addressing whether the impairment limits the operation of a major bodily function by responding 'yes' or 'no'.
8. In the following section, describe any essential functions of the employee's job that they are unable to perform due to their limitations. List specific functional limitations or restrictions associated with major life activities.
9. Provide any suggestions or comments regarding effective accommodations that could support the employee in performing their job functions.
10. Complete the medical provider information section by entering the medical provider's name, practice, address, city, state, zip code, telephone, and email.
11. Finally, have the medical provider sign and date the form. Once completed, return the form to Human Resources by mailing or emailing it as indicated at the bottom.

Complete the form online to expedite the accommodation request process.