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Americans with Disabilities Act (ADA) Accommodation Request Form Date: EMPLOYEE INFORMATION (PART 1) 2026
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- Click ‘Get Form’ to open the ADA Accommodation Request Form in the editor.
- Begin by filling out your personal information in the EMPLOYEE INFORMATION section. Enter your name, work site, address, position, city, state, zip code, home phone, cell phone, and email.
- In the detailed response section, clearly describe the situation or condition prompting your accommodation request. Be specific about the nature of your impairment and whether it is chronic or temporary.
- Next, outline how your job responsibilities will be affected by this accommodation request. This helps clarify your needs to HR.
- Specify the accommodations you are proposing and provide an anticipated length for these accommodations.
- Finally, sign and date the form at the bottom to validate your request before submitting it to HR.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4 Satisfied (55 Votes) |
What is an ADA accommodation request?
Reasonable accommodation is any change or adjustment to a job or work environment that permits a qualified applicant or employee with a disability to participate in the job application process, to perform the essential functions of a job, or to enjoy benefits and privileges of employment equal to those enjoyed by
How to write an ADA accommodation request?
Content to consider in body of letter: Identify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.
What does ADA mean in accommodation?
Reasonable accommodation can include, but is not limited to, the following: Changing job duties. Providing leave for medical care. Changing work schedules. Relocating the work area. Providing mechanical or electrical aids.
What time period does an employer need to respond to an ADA request?
According to the EEOC, there is no specific amount of time that employers have to respond to an accommodation request, but they should respond as quickly as possible. Unnecessary delays in responding or implementing an accommodation can result in a violation of the ADA.
What qualifies you for ADA accommodations?
Under the ADA , you have a disability if you have a physical or mental impairment that substantially limits a major life activity. The ADA also protects you if you have a history of such a disability, or if an employer believes that you have such a disability, even if you dont.
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People also ask
What is Title 1 of the ADA?
Title I of the Americans with Disabilities Act of 1990 prohibits private employers, State and local governments, employment agencies and labor unions from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training, and other
What is an example of an accommodation request?
The duty to engage in the interactive accommodation process under title I of the Americans with Disabilities Act (ADA) is triggered when a request for reasonable accommodation is received, or when an employer has a reasonable belief that an employee may need accommodation due to a known disability that is affecting job
Related links
This form is to be used to make a request for reasonable accommodation of a physical or mental disability as outlined in the Rehabilitation Act of 1973,
May 9, 2016 This document provides general information to employers and employees regarding leave related to an employees disability.