The 9.42 Elements of Claim: Reasonable Accommodation form is a legal document used to establish a plaintiff's claim for reasonable accommodation due to a disability. This form outlines the necessary elements that must be proven for a verdict in favor of the plaintiff, including the existence of a substantial impairment, the employer's knowledge of that impairment, and the failure to provide reasonable accommodations. It differs from other employment-related forms by specifically focusing on disability claims under the Americans with Disabilities Act (ADA) and the obligations of employers regarding accommodations.
This form should be used when an employee with a disability believes their employer failed to provide reasonable accommodations that would have allowed them to perform essential job functions. Typical scenarios include cases where an employee requests specific modifications to their work environment or schedule due to their disability, but the employer does not comply with those requests.
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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

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Providing an assistant as needed may be a reasonable accommodation for a person with a disability, if this does not impose an undue hardship. Examples include: An assistant may be needed to retrieve items on shelves, file, or selectively assist a person with quadriplegia with other clerical duties.
Examples of Reasonable Accommodations Job restructuring such as altering when and/or how an essential function of a job is performed or reallocating marginal job functions that an employee is unable to perform because of a disability.
Examples of reasonable accommodation include making existing facilities used by employees readily accessible to and usable by an individual with a disability; restructuring a job; modifying work schedules; acquiring or modifying equipment; providing qualified readers or interpreters; or appropriately modifying
There are three categories of "reasonable accommodations": changes to a job application process. changes to the work environment, or to the way a job is usually done. changes that enable an employee with a disability to enjoy equal benefits and privileges of employment (such as access to training).
Reasonable accommodation does not include removing essential job functions, creating new jobs, and providing personal need items such as eye glasses and mobility aids. Nothing in the ADA prohibits employers from providing these types of accommodations; they simply are not required accommodations.
Reasonable accommodations are. modifications or adjustments made to a job or work environment that enable a qualified person who has a disability to perform the essential functions of that job.
Reasonable accommodation can include, but is not limited to, the following: Changing job duties. Providing leave for medical care. Changing work schedules. Relocating the work area. Providing mechanical or electrical aids.
Examples of reasonable accommodations include: making the workplace accessible to and usable by an employee with a disability, restructuring a job, modifying work schedules, providing qualified readers for individuals who are blind, providing sign language interpreters to people who are deaf, providing periods of leave