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FACULTY/STUDENT/RESIDENT REQUEST FOR ACCOMMODATION UNDER THE
AMERICANS WITH DISABILITIES ACT (ADA)
Purpose:
Form ADA-100 is used by an individual to submit a request for accommodation.
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How to fill out employee request for accommodation

How to fill out an employee request for accommodation:
01
Start by clearly identifying the employee's name, contact information, and job position in the designated fields.
02
Provide a detailed explanation of the nature of the requested accommodation. Specify any physical or mental disability, medical condition, or religious belief that necessitates the accommodation.
03
Outline the specific accommodations needed to perform job duties effectively. Include any necessary adjustments to the workspace, work schedule, equipment, or job responsibilities.
04
If applicable, provide supporting documentation such as medical records, diagnostic evaluations, or religious certification to validate the request.
05
Clearly state the expected duration of the accommodation and any additional information regarding the frequency or need for recurring accommodations.
06
Sign and date the request form to indicate acknowledgment and consent.
Who needs an employee request for accommodation?
01
Employees with disabilities: Individuals with physical or mental disabilities may need specific accommodations in the workplace to ensure equal opportunities for employment and productivity.
02
Employees with medical conditions: Individuals with medical conditions that impact their ability to perform certain job tasks may require accommodations to perform their duties effectively and safely.
03
Employees with religious beliefs: Employees may request accommodations based on religious beliefs or practices that require time off, adjustments to work schedules, or modifications to dress codes.
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What is employee request for accommodation?
Employee request for accommodation is a formal request made by an employee to their employer for adjustments or changes to their job or work environment in order to accommodate a disability or medical condition.
Who is required to file employee request for accommodation?
Any employee who requires accommodations due to a disability or medical condition is required to file an employee request for accommodation with their employer.
How to fill out employee request for accommodation?
To fill out an employee request for accommodation, the employee should typically submit a written request to their employer outlining the accommodations needed and providing any supporting documentation.
What is the purpose of employee request for accommodation?
The purpose of employee request for accommodation is to ensure that employees with disabilities or medical conditions are provided with the necessary accommodations to perform their job duties effectively.
What information must be reported on employee request for accommodation?
Employee request for accommodation should include information about the specific accommodation needed, the reasons for the accommodation, and any supporting documentation from a healthcare provider.
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