Get the free Reasonable Accommodation Request Form - cityofsalem

This form is used to request reasonable accommodations from a City Department for programs, services, activities, policies, or communications.

How to fill out reasonable accommodation request form

How to fill out Reasonable Accommodation Request Form

1. Obtain the Reasonable Accommodation Request Form from your employer or HR department.
2. Read the instructions carefully to understand the requirements.
3. Fill out your personal information at the top of the form, including your name, job title, and contact information.
4. Specify the nature of your disability and how it affects your ability to perform your job.
5. Describe the specific accommodation you are requesting and how it will assist you.
6. If necessary, provide supporting documentation from a medical professional.
7. Sign and date the form to certify that the information is accurate.
8. Submit the completed form to your HR department or designated contact.

Who needs Reasonable Accommodation Request Form?

1. Employees with disabilities who require adjustments in the workplace to perform their job effectively.
2. Individuals involved in the hiring process who may need accommodations to participate in interviews.
3. Employees returning to work after a medical leave who require modifications to their work environment.

People Also Ask about

What is an example of a reasonable accommodation statement?

Abbreviated Reasonable Accommodation Statement To be used when space is limited: Anyone with a disability who would like to request accommodations or who has questions about physical access may contact [insert email and telephone number of the program/event sponsor] in advance of the program or visit.

What to say in a reasonable accommodation request?

(Name of public entity) does not discriminate on the basis of disability in its services, programs, or activities. Employment: (Name of public entity) does not discriminate on the basis of disability in its hiring or employment practices and complies with the ADA title I employment regulations.

What is an example of an accommodation statement?

Write down precisely what job-related limitations your condition imposes and note how they can be overcome by accommodations. Identify potential accommodations and assess how effective each would be in allowing you to perform the job. Document all aspects of the accommodation--including cost and availability.

How do you write a good reasonable accommodation request?

Write down precisely what job-related limitations your condition imposes and note how they can be overcome by accommodations. Identify potential accommodations and assess how effective each would be in allowing you to perform the job. Document all aspects of the accommodation--including cost and availability.

Is there an ADA accommodation form?

ing to the Equal Employment Opportunity Commission (EEOC), the federal agency charged with enforcing the ADA, an accommodation request does not have to be in writing and the ADA does not include specific guidelines or forms for requesting reasonable accommodation.

What documentation is needed for a reasonable accommodation?

Sufficient medical documentation should describe the nature, severity, and duration of the impairment, the activity or activities that the impairment limits, the extent to which the impairment limits the employee's ability to perform the activity or activities, and should also substantiate why the requested reasonable

What are examples of reasonable accommodations?

Sample Statements If you need disability-related accommodations, please call [insert telephone number of the sponsor]. Persons with disabilities who anticipate needing accommodations or who have questions about physical access may call [telephone number of the sponsor] in advance of the program [or film, event, etc.].

For pdfFiller’s FAQs

What is Reasonable Accommodation Request Form?

The Reasonable Accommodation Request Form is a document used by individuals to request modifications or adjustments in the workplace or academic environment to accommodate their disabilities.

Who is required to file Reasonable Accommodation Request Form?

Individuals with disabilities who require accommodations to perform their job duties or participate in educational programs are required to file the Reasonable Accommodation Request Form.

How to fill out Reasonable Accommodation Request Form?

To fill out the Reasonable Accommodation Request Form, applicants should provide personal information, detail their disability, specify the accommodations needed, and include any supporting documentation from healthcare providers if necessary.

What is the purpose of Reasonable Accommodation Request Form?

The purpose of the Reasonable Accommodation Request Form is to facilitate the process of requesting accommodations, ensuring that individuals with disabilities can access equal opportunities in the workplace or educational settings.

What information must be reported on Reasonable Accommodation Request Form?

The information that must be reported includes the individual's name, contact information, description of the disability, specific accommodations being requested, and any relevant medical or eligibility documentation.