Workplace Accommodation Request Template
A form for employees to request a workplace accommodation and share relevant limitations, supporting documents, and expected duration with the designated workplace contact.
When to use it
- An employee needs an adjustment to perform their job
- A team member requests a change to their schedule or workspace
- HR needs details to review an accommodation request
- An employee needs to update the expected duration of an accommodation
What it asks
- Your name
- Work email
- Phone number
- What limitation are you experiencing?
- What accommodation are you requesting?
- How would this accommodation help you at work?
- Upload a supporting document
- How long do you expect to need this accommodation?
Why it should be encrypted
Limitations and supporting documents may reveal private health or personal information. Keep responses available only to the designated HR or workplace contact, not coworkers or people who do not need them.
Tips
- Ask employees to describe only the limitation details needed to consider the request.
- Tell employees which designated contact will review their response and uploaded document.
- Customize the duration options to fit your workplace's review process.