Request for Accommodation Request Record

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Last UpdatedFebruary 8, 2023
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Version2023

This form should be provided to employees who request a reasonable accommodation. Please see the Easy Steps for a full guide on the Reasonable Accommodation packet.


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ADA00003 Reasonable Accommodation Request Record.pdf
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Note: This sample form is provided as a tool for employers. This form is general in nature, and may not be required by law. ManagEase is not a law firm. This form does not constitute legal advice, nor is any attorney-client relationship created or implied. Prior to using this form, we recommend that you consult with an attorney knowledgeable in any potentially applicable federal and/or state laws regarding the specific intended use of this form.
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