Get the free Job Accommodation Request

Attach any information you have that supports the limitations described Name of treating physician Phone Mailing address Fax City St. necessary Length of Accommodation check one Permanent Is this accommodation related to an on-the-job-injury Temporary number of months Yes Supervisor s signature Date Employee s signature Manager s signature Mail Job Accommodation Request Form to Not Approved Evaluation/Follow-up Revised 7/2016 If yes what was the date of injury Disability Management One...

How to fill out job accommodation request

How to fill out job accommodation request

1. Review the job accommodation policy of your organization
2. Identify the need for accommodation based on a disability or medical condition
3. Obtain the job accommodation request form from your Human Resources department
4. Fill out the personal details section of the form, including your name, job title, and contact information
5. Specify the accommodation you are requesting, providing details on how it will enable you to perform your job effectively
6. Include any supporting documentation, such as medical reports or recommendations from healthcare professionals
7. Submit the completed form along with the necessary documentation to your supervisor or Human Resources department
8. Engage in a dialogue with your employer to discuss the accommodation request
9. Cooperate with any further assessments or evaluations that may be necessary to determine the appropriateness of the accommodation
10. If the request is approved, work with your employer to implement the accommodation
11. Follow up with your employer to ensure the accommodation is effective and meets your needs

Who needs job accommodation request?

1. Employees with disabilities or medical conditions that hinder their ability to perform essential job functions
2. Individuals who require adjustments or modifications in the workplace to overcome barriers
3. Employees who have undergone medical treatments or surgeries and need temporary accommodations
4. Job applicants with disabilities who may need accommodations during the interview or hiring process
5. Employees with chronic health conditions that require flexibility or modifications in work schedules
6. Pregnant employees who need temporary accommodations due to physical limitations
7. Workers recovering from injuries or illnesses who need support to safely resume their job duties

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What is job accommodation request?

Job accommodation request is a formal request made by an employee to make changes in the workplace in order to accommodate a disability or medical condition.

Who is required to file job accommodation request?

Any employee who needs accommodation for a disability or medical condition is required to file a job accommodation request.

How to fill out job accommodation request?

Employee can fill out a job accommodation request form provided by their employer or HR department, or can submit a written request outlining their needs and reasons for accommodation.

What is the purpose of job accommodation request?

The purpose of job accommodation request is to ensure that employees with disabilities or medical conditions are provided with reasonable accommodations to perform their job duties.

What information must be reported on job accommodation request?

Job accommodation request should include details about the employee's disability or medical condition, specific accommodations needed, and how the accommodation will enable the employee to perform their job effectively.