Get the free Reasonable Accommodation Request Form For Employees - ode uconn

This form is for employees at the University of Connecticut requesting reasonable accommodations under the ADA and related laws, requiring information about their medical condition and job functions.

How to fill out reasonable accommodation request form

How to fill out Reasonable Accommodation Request Form For Employees

1. Obtain the Reasonable Accommodation Request Form from your HR department or employee portal.
2. Fill in your personal information, including your name, employee ID, and department.
3. Provide details about your medical condition or disability that necessitates accommodation.
4. Specify the type of accommodation you are requesting, being as specific as possible.
5. Include any supporting documentation from your healthcare provider, if necessary.
6. Sign and date the form to acknowledge that the information provided is accurate.
7. Submit the completed form to your HR department or designated personnel.

Who needs Reasonable Accommodation Request Form For Employees?

1. Employees with disabilities who require assistance to perform their job duties.
2. Employees returning to work after a medical leave due to disability.
3. Employees experiencing a temporary medical condition affecting their work capabilities.
4. Employees seeking to modify their work environment or schedule for health-related reasons.

People Also Ask about

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.

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 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 is an example of an accommodation letter for an employee?

I have a disability as defined by the Americans with Disabilities Act, and I need this accommodation to successfully perform my job. If you have alternative suggestions regarding reasonable accommodations, please share them with me so we can work together to find a workable and effective accommodation.

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.].

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 ADA approval letter?

The health care provider's note you provided to us on [date] stated that you have the following work restriction(s): [list restrictions]. We met with you on [date] to discuss possible accommodations needed because of these restrictions. We have approved the following accommodation(s): [list accommodations].

What is an example of an ADA letter to an employee?

Dear [Employee name]: On [date], you informed [name and title] of your medical condition and requested a job accommodation to be able to perform your job functions. [Company Name] complies with the Americans with Disabilities Act (ADA), and we want to support you in continuing to perform your job duties.

What are some ADA examples?

The ADA prohibits discrimination based on disability. Under the ADA, it is illegal to discriminate against someone because of their disability. For example, a fitness center could not exclude a person who uses a wheelchair from a workout class because they cannot do all of the exercises in the same way.

How do you write a request for reasonable accommodation?

Reasonable Accommodation Sample Letter Dear (Employer name), I have worked for you for (years/months/days) as a (job title). I am a qualified individual with a disability. By this I mean, I have a medical condition and I can perform the essential functions of (job title) with a reasonable accommodation.

For pdfFiller’s FAQs

What is Reasonable Accommodation Request Form For Employees?

The Reasonable Accommodation Request Form for Employees is a document used by employees to formally request modifications or adjustments to their work environment or job responsibilities to accommodate their disabilities or other personal needs.

Who is required to file Reasonable Accommodation Request Form For Employees?

Employees who have a disability or require modifications to their work environment or job duties due to health-related issues are required to file the Reasonable Accommodation Request Form.

How to fill out Reasonable Accommodation Request Form For Employees?

To fill out the Reasonable Accommodation Request Form, employees need to provide their personal information, describe their disability or need for accommodation, specify the type of accommodation requested, and include any relevant medical documentation to support their request.

What is the purpose of Reasonable Accommodation Request Form For Employees?

The purpose of the Reasonable Accommodation Request Form is to facilitate the process of requesting accommodations, ensuring that the employer understands the needs of the employee and can respond appropriately to maintain an inclusive and compliant workplace.

What information must be reported on Reasonable Accommodation Request Form For Employees?

The information that must be reported on the Reasonable Accommodation Request Form includes the employee's name, contact details, description of the disability or limitation, the specific accommodations being requested, and any supporting documentation from healthcare providers.