Pennsylvania Reasonable Accommodation Request Form

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

Description

This form may be used to assist a company in determining to what extent a reasonable accommodation is required.
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How to fill out Reasonable Accommodation Request Form?

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FAQ

Re: Request for Reasonable Accommodation for (Your Name)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.

According to the EEOC, you only have to let your employer know that you need an adjustment or change at work for a reason related to a medical condition. You can use "plain English" to make your request and you do not have to mention the ADA or use the phrase "reasonable accommodation."

How To Request AccommodationsKeep it simple. You can tell your employer that you need an adjustment or change because of a medical condition.Put it in writing.Talk to the right people.How it works: an example.Finding help.

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.

I would like to request accommodations for your class. I have copied my coordinator (name) and have attached my verification letter. I would like to set up a time to discuss this information with you to determine how we can implement accommodations. Please let me know your convenient time.

What types of accommodations are generally considered reasonable?Change job tasks.Provide reserved parking.Improve accessibility in a work area.Change the presentation of tests and training materials.Provide or adjust a product, equipment, or software.Allow a flexible work schedule.More items...

Sample Accommodation Request LetterIdentify 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.More items...

An employer may ask if you can perform the essential functions of the job, with or without accommodations, but it is against the law to directly ask if you have any disabilities. Instead, it is up to you, the employee, whether or not to give this information.

Under Title I of the Americans with Disabilities Act (ADA), a reasonable accommodation is a modification or adjustment to a job, the work environment, or the way things are usually done during the hiring process.

An individual meets the Americans with Disabilities with Act definition act of disability that would qualify them for reasonable accommodations if they have a physical or mental impairment that substantially limits one or more major life activities (sometimes referred to in the regulations as an actual disability)

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Pennsylvania Reasonable Accommodation Request Form