Request For Reasonable Accommodation Form (pdf)

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

Description

The Request for Reasonable Accommodation Form (pdf) is designed to help employers assess the need for workplace accommodations for employees with disabilities. This form allows the employee to detail their limitations and request specific accommodations to perform their job effectively. It consists of three main sections: Section I for the employee to submit their request and personal information, Section II for the employer to confirm the request and any necessary analyses, and Section III for Human Resources to coordinate with healthcare professionals if needed. It emphasizes confidentiality, stating that the submitted information should not be included in the employee's personnel file. This form is essential for various legal personnel, including attorneys, partners, owners, associates, paralegals, and legal assistants, as it ensures compliance with the Americans with Disabilities Act. By utilizing this form, these professionals can facilitate a smoother process for requesting necessary accommodations, ensuring legal obligations are met while supporting employees in need. Proper completion and submission of this form can significantly enhance an employee's ability to perform their job and contribute positively to the workplace.
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FAQ

Dear Mr./Ms. (Contact at Human Resources Department): I work at ________(Company Name) as a ________(Your Job Title) and have been in this position since ____ (Date). I am writing to request that you provide __________________(list accommodation needed here) as a reasonable accommodation under the ADA.

Content to consider in body of letter: Identify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.

An employer may use this form to document the determination of an employee's request for a reasonable accommodation under the Americans with Disabilities Act (ADA). The form is intended for private employers.

Content to consider in body of letter: Identify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.

?We value inclusion and access for all participants and are pleased to provide reasonable accommodations for this event. Please contact [insert contact name and email/phone number] to make a reasonable accommodation request. Requests must be submitted by [insert date].? ?This event is wheelchair accessible.

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Request For Reasonable Accommodation Form (pdf)