Get Eng 6042-1 2012-2025

Filling out the ENG 6042-1 form is a crucial step in the process of requesting reasonable accommodations for individuals with disabilities. This guide will provide you with clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the ENG 6042-1 form online.

1. Click ‘Get Form’ button to obtain the ENG 6042-1 form and open it in the online editor.
2. Begin filling out Section 1 by entering the employee's name in the format of last name, first name, and middle initial.
3. Provide the office contact telephone number of the employee in Section 3, ensuring the format is correct for clarity.
4. In Section 2, enter the physician's name using the same format: last name, first name, and middle initial.
5. Complete Section 4 by detailing the physician's address, including street, city, state, and zip code.
6. In Section 5, provide a detailed diagnosis of the requestor's current medical condition(s) as outlined by the healthcare provider.
7. Section 6 requires the prognosis, including any plans for future treatment and an estimated date for full or partial recovery.
8. Indicate in Section 7 whether the medical condition(s) result in any impairment.
9. In Section 8, describe the nature, severity, and duration of the impairment.
10. For Section 9, list the activity or activities that the impairment limits.
11. Explain in Section 10 the extent to which the impairment limits the individual’s ability to perform specific job functions that are required in their current position.
12. In Section 11, provide the reasons why the requestor requires reasonable accommodation or the specific reasonable accommodation being requested.
13. In the signature certification section, Section 12a, enter the physician's name once more.
14. Complete section 12b with the date in the format YYYYMMDD.
15. Section 12c requires the physician's signature to certify the information provided.
16. Once all sections are completed, review the form for accuracy, then save changes, and download or print the completed form as needed.

Start filling out the ENG 6042-1 form online to ensure your reasonable accommodation request is processed smoothly.