Get the free Employee Accommodation Request Form DRAFT 7.20.2010

Human Resources ADA ACCOMMODATION REQUEST FORM Employee Name: Date: Department: Supervisor: A. Questions to clarify accommodation requested What specific accommodation are you requesting? If you are

How to fill out employee accommodation request form

How to fill out employee accommodation request form

1. Read the instructions carefully before starting to fill out the employee accommodation request form.
2. Provide your personal details such as name, employee ID, and contact information.
3. Specify the effective date of the accommodation request.
4. Indicate the type of accommodation being requested, whether it's a physical accommodation, schedule modification, or other.
5. Explain the reason for the accommodation request in detail, providing any necessary supporting documentation.
6. If applicable, list any medical conditions or disabilities that require the accommodation.
7. Provide information about any previous accommodation requests made for the same issue.
8. Include any additional information or special instructions that may be relevant for the request.
9. Sign and date the form to acknowledge that the information provided is accurate and complete.
10. Submit the completed employee accommodation request form to the designated department or supervisor.

Who needs employee accommodation request form?

1. Employees who require accommodations due to a disability or medical condition.
2. Employees who have scheduling conflicts and need modifications to their work schedule.
3. Employees who need physical accommodations in the workplace to perform their job duties effectively.
4. Employees who have other valid reasons for requesting accommodations in their employment.

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What is employee accommodation request form?

The employee accommodation request form is a document used by employees to request accommodation for any disabilities or medical conditions that may impact their ability to perform their job duties.

Who is required to file employee accommodation request form?

Employees who require accommodation for disabilities or medical conditions that affect their job performance are required to file the employee accommodation request form.

How to fill out employee accommodation request form?

To fill out the employee accommodation request form, employees must provide information about their disability or medical condition, the requested accommodation, and any supporting documentation from a healthcare provider.

What is the purpose of employee accommodation request form?

The purpose of the employee accommodation request form is to ensure that employees with disabilities or medical conditions receive the necessary accommodations to perform their job duties effectively.

What information must be reported on employee accommodation request form?

Employees must report information about their disability or medical condition, the requested accommodation, and any supporting documentation from a healthcare provider on the employee accommodation request form.