CONFIDENTIAL Reasonable Accommodation Request Form 2025

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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 employees ability to perform the activity or activities, and should also substantiate why the requested reasonable
The law does not require the use of this or any other form to make a request for a reasonable accommodation. This form and any supporting materials or information is confidential and should be kept separate from an employees personnel file.
Your employer can claim undue hardship, which means it would be too expensive or difficult for them to provide the proposed accommodation.
A detailed, comprehensive written report from your treating professional describing your disability and its impact on your daily functioning. The report should also explain the need for the requested accommodations relative to your impairment.
The first step in the reasonable accommodation process is disclosure of a disability, as employers are only required to accommodate disabilities of which they are aware.

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The California Fair Employment and Housing Act requires employers of five or more employees to provide reasonable accommodation for individuals with a physical or mental disability to apply for jobs and to perform the essential functions of their jobs unless it would cause an undue hardship.
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.

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