Accommodation Request Determination: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in the 'NAME OF EMPLOYEE/APPLICANT MAKING THE REQUEST' field. This identifies you as the requester.
If applicable, fill in your official title in the 'EMPLOYEE OFFICIAL TITLE' section. If you are an applicant, leave this blank.
Provide your contact information as the Decision Making Official (DMO) in the designated fields, including name, phone number, and email address.
In section 7, indicate how the requested accommodation will assist you—whether for applying/interviewing for a job or performing essential job functions.
Describe the specific accommodation you are requesting in section 8. Be clear and concise to ensure understanding.
Review sections 9 through 12 carefully. These sections detail decisions regarding your request and any alternative accommodations offered by the DMO.
Complete any additional required fields regarding acceptance or rejection of accommodations and provide necessary signatures where indicated.

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What are good reasons for reasonable 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.

How to evaluate a reasonable accommodation request?

To help determine effective accommodations, the Equal Employment Opportunity Commission (EEOC), recommends that employers use an interactive process, which simply means that employers and those individuals with disabilities who request accommodations work together to come up accommodation solutions.

What documentation is needed for a reasonable accommodation request?

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

What qualifies as a disability for reasonable accommodation?

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)