Accommodation Request Statement With Multiple Conditions

State:
Multi-State
Control #:
US-216EM
Format:
Word; 
Rich Text
Instant download

Description

The Reasonable Accommodation Request Form is designed to facilitate the process of requesting accommodations for employees with disabilities, ensuring they can perform essential job functions effectively. This form must remain confidential and separate from the employee's personnel file. Employees fill out the initial section, detailing their job title, contact information, and the nature of their disabilities. They must also outline how their conditions impede their job duties and propose potential accommodations that could assist them. Employers complete the second section to verify the employee's request and analyze essential job functions before forwarding it to Human Resources. The last section focuses on obtaining and assessing documentation from health care professionals regarding the employee's impairment and its impact on their job performance. Key features include clear confidentiality stipulations, structured sections for both employee and employer input, and an opportunity for health care professional involvement, ensuring due diligence in accommodating employees. This form is particularly beneficial for attorneys, partners, owners, associates, paralegals, and legal assistants, as it provides a streamlined process for documenting and assessing accommodation requests while adhering to the Americans with Disabilities Act.
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FAQ

I would like to request accommodations so that I might be able to perform my job effectively before my performance starts to suffer. Workplace distractions interfere with my concentration and focus so I would like to try noise cancelling headphones to minimize sound distractions.

RA Statement Example: [Employer] is committed to providing access and reasonable accommodation in its services, activities, programs, and employment opportunities in ance with the Americans with Disabilities Act and other applicable laws.

In your reasonable accommodation letter, you should provide all the information your employer will need to begin the accommodation process, including what your disability is, how it affects you, which aspects of your job might require modification, and proposed accommodations.

As part of this commitment, [Employer] will ensure that persons with disabilities are provided reasonable accommodations for the hiring process. If reasonable accommodation is needed, please contact [include name and/or department, telephone, and e-mail address, etc.].

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Accommodation Request Statement With Multiple Conditions