Accommodation Request Form Template

An Accommodation Request Form is a document used by employees to request reasonable accommodations in the workplace due to disability, medical needs, religious practices or other legally protected reasons. This request form helps employers evaluate and provide necessary adjustments while ensuring compliance with accommodation policies.

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Accommodation Request Form for submitting workplace accommodation due to disability, religion or medical needs

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Frequently asked questions

An Accommodation Request Form is a formal document used by employees to request reasonable adjustments in the workplace due to a disability, medical condition, religious practice or other protected reason. This request form for accommodation includes employee information, the type of accommodation needed, the reason for the request and any supporting documentation. Submitting this form starts the interactive process between the employee and employer to explore appropriate accommodations in compliance with legal and workplace standards.
Any employee who needs an accommodation to perform their job duties or fully participate in workplace activities should complete this Accommodation Request Form. This includes those with physical, mental, or temporary disabilities or those requiring religious or pregnancy-related accommodations.
Submit the completed Accommodation Request Form to your company’s Human Resources department or designated accommodation officer.

Accommodation Request Form Template

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