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Request for Accommodation Form - Digital

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A digital, attorney-reviewed form to help employers document any requests for reasonable accommodation from qualified applicants or employees due to their physical or mental disability.

Request for Accommodation Form - Digital

Title I of the Americans with Disabilities Act of 1990 (ADA) and many state disability discrimination laws require an employer to provide reasonable accommodation to qualified individuals with disabilities, unless doing so would cause undue hardship to the business. Reasonable accommodations must be provided to qualified applicants if needed during the hiring process and to covered employees, regardless of whether they work part-time or full-time, or are considered "probationary." Generally, the individual with a disability must inform the employer of the need for an accommodation. To demonstrate compliance with the ADA and/or state disability discrimination laws, employers should document such requests and retain them in accordance with applicable recordkeeping requirements. 

Our attorney-reviewed Request for Accommodation Form allows employers to document both an individual’s accommodation request and the company’s corresponding determination as to whether it is approved or denied.  Employers can provide this form to any employee seeking a change to their job duties, workspace, equipment, or schedule to help them perform the essential functions of their job. 

 It includes space to capture the details of the individual’s request, the purpose of the accommodation, the root issue or problem that the requested change would address, and the employer’s final decision.  

Features & Benefits Include:

  • A digital form to document requests from qualified individuals to accommodate a physical or mental disability, including space for the company to document its final determination on whether to approve or deny the request; 
  • Attorney-reviewed to ensure compliance with the Americans with Disabilities Act (ADA) and state anti-discrimination laws; 
  • Printable, fill-in-the-blanks digital format for physical or electronic recordkeeping;
  • A detailed instruction sheet explaining how & when to use the form and how long to retain it.

Our attorney-reviewed form is designed to help employers:

  • Demonstrate good faith compliance with the Americans with Disabilities Act (ADA) and/or state anti-discrimination laws. 
  • Document the reason for the individual’s request, the details of the accommodation, and the final determination as to whether the request is approved or denied.   


  • If you are not completely satisfied, you can cancel your order within seven (7) days of receipt for a full refund.




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