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Click ‘Get Form’ to open the medical questionnaire accommodation in the editor.
Begin by entering the employee's name, UIN, job title, and department in the designated fields. Ensure no abbreviations are used for clarity.
In section A, answer questions regarding the employee's physical or mental impairment. Indicate whether it is long-term or permanent and provide details about its frequency and duration.
Proceed to section B, where you will describe how the impairment interferes with job performance. Be specific about essential functions affected.
Finally, in section C, suggest possible accommodations that could assist the employee in meeting job requirements. Provide detailed explanations for each suggestion.
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What are the 5 common means of reasonable accommodation?
Commonly Utilized Accommodations Electronic copies of notes, handouts, overheads, or chalkboard notes. Use of a scribe or note taker. Seating locations (close to the chalkboard or screen) Tape-recorded lectures. Taped textbooks. Alternate test format: oral, Braille, or large print.
What are the medical questions for reasonable accommodation?
Under the ADA, in response to an accommodation request, an employer may ask what impairment is involved, why medication is needed, and its impact on job performance.
What are examples of medical accommodations?
Examples of reasonable accommodations include providing interpreters, readers, or other personal assistance; modifying job duties; restructuring work sites; providing flexible work schedules or work sites (i.e. telework) and providing accessible technology or other workplace adaptive equipment.
What are the most common accommodations?
An individual meets the Americans with Disabilities with Act definition act of disability that would qualify them for reasonable accommodations if they have a physical or mental impairment that substantially limits one or more major life activities (sometimes referred to in the regulations as an actual disability)
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Medical Questionnaire for Reasonable Accommodation
Mar 5, 2024 INSTRUCTIONS: The information requested on this form pertains only to the condition for which the employee is requesting accommodation under the
Answer the questions on this form to help determine disability and reasonable accommodation using the employees current position description. Under the
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