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This document allows qualified individuals with disabilities to self-identify and request reasonable accommodations under the Americans with Disabilities Act.
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How to fill out employee self-identification of disability

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How to fill out Employee Self-Identification of Disability and Request for Reasonable Accommodation

01
Begin by reading the form carefully to understand the instructions.
02
Provide your personal information, including your name, employee ID, and department.
03
Indicate whether you have a disability by checking the appropriate box.
04
If applicable, describe your disability in detail to provide context for accommodation requests.
05
Complete the section that asks for the type of reasonable accommodation you are requesting.
06
Review your answers for accuracy and completeness before submission.
07
Submit the completed form to your HR department or designated personnel.

Who needs Employee Self-Identification of Disability and Request for Reasonable Accommodation?

01
Employees who have a disability and require accommodations to perform their job effectively.
02
New hires who wish to self-identify their disability for the company's records.
03
Current employees who need to update their disability status or accommodation requests.
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The best way to do this is to consult informally with the applicant or employee about potential accommodations that would enable the individual to participate in the application process or perform the essential functions of the job.
Under the ADA, the definition of a disability requires that impairments substantially limit the ability to perform major life activities. Major life activities are basic activities that most people can perform with little or no difficulty.
The law defines disability as the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
Self-identification is a voluntary and confidential reporting of one's disability status. In the past this was accomplished through the Americans with Disabilities Act (ADA) Coordinator within your department. Employees can now self-identify as a person with a disability through the Employee Self-Service.
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.
You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition.
If you have obvious difficulty walking or doing ordinary tasks, If you are noticeably blind, deaf, or speech impaired, If you have significant age-related physical or cognitive impairments, If you look or act "different" enough to raise questions about whether you might have a disability or some such condition.
If you have obvious difficulty walking or doing ordinary tasks, If you are noticeably blind, deaf, or speech impaired, If you have significant age-related physical or cognitive impairments, If you look or act "different" enough to raise questions about whether you might have a disability or some such condition.

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Employee Self-Identification of Disability and Request for Reasonable Accommodation is a process through which employees disclose their disability status and request modifications or adjustments in the workplace to accommodate their needs, ensuring compliance with disability rights laws.
All employees who have disabilities or who believe they may need reasonable accommodations due to a disability are encouraged to file this request. Employers may also invite voluntary self-identification as part of diversity and inclusion efforts.
To fill out the form, employees should provide personal information as required, including their contact details, specify their disability status if applicable, and describe the specific accommodations they are requesting.
The purpose is to promote an inclusive workplace by identifying employees who may need accommodations due to disabilities, ensuring they receive support to perform their jobs effectively and comply with legal obligations related to disability rights.
Employees must report basic information such as their name, job title, and department, alongside any relevant details about their disability or the nature of the requested accommodation. Specific forms may outline additional requirements.
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