Wyoming Reasonable Accommodation Request Form

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Multi-State
Control #:
US-216EM
Format:
Word; 
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Description

This form may be used to assist a company in determining to what extent a reasonable accommodation is required.
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FAQ

Examples of reasonable accommodations include making existing facilities accessible; job restructuring; part-time or modified work schedules; acquiring or modifying equipment; changing tests, training materials, or policies; providing qualified readers or interpreters; and reassignment to a vacant position.

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.

How to Handle an Employee's Request for an ADA AccommodationStep 1: Determine Whether the Employer Is Covered by the ADA.Step 2: Ensure a Policy and Procedure Exist for Handling Accommodation Requests.Step 3: Determine Whether the Employee with a Disability Is "Qualified"Step 4: Initiate the Interactive Process.More items...

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.

Steps for Requesting AccommodationsComplete a Getting Started Form. This basic form consists of contact information and five brief questions.Provide DSS with current disability related documentation.Meet with DSS for an intake appointment.Request Your Accommodations Each Term.

What do I do? Your first step is to request the reasonable accommodation. Let your supervisor(s) or human resource department know that you need a change at work because of reasons related to your medical condition. You may make this request initially to whomever you are most comfortable with.

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...

Under state law, the following are not reasonable accommodations: Providing a personal care assistant. Personal aids unrelated to work such as wheelchairs or glasses. Any accommodation that is unreasonable given the employer's particular circumstances and operations, such that it would pose an undue hardship.

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Wyoming Reasonable Accommodation Request Form