Accommodation Case File Template
Accommodation Case File Template for documenting an ADA request, the interactive process, supporting information, the decision, and follow-up actions in one place.
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Overview
This Accommodation Case File Template is a structured HR form for documenting an employee’s accommodation request, the interactive process, any supporting information received, the decision, and the follow-up plan. It is designed to create one clear case record from first notice through implementation, so the team can track what was requested, what was considered, and what action was taken.
Use it when an employee asks for a change to a schedule, workspace, equipment, duties, communication method, or another workplace adjustment tied to a limitation or barrier. The template helps you capture the essential job functions affected, note whether medical information is needed, record consent to review supporting information, and document interim measures while the case is still open. It also supports confidentiality by keeping the record focused on the case rather than broad personnel history.
Do not use this as a general performance form or a disciplinary record. It is also not the right place to collect unnecessary PII, detailed medical history, or unrelated background information. If the request is informal, partial, or still evolving, the template still works because it supports progressive disclosure and lets you document the conversation before a final decision is made. If your organization needs a separate legal review or medical review workflow, this case file should sit alongside that process, not replace it.
Standards & compliance context
- This template supports ADA accommodation documentation by preserving the interactive process, decision rationale, and follow-up in one audit trail.
- The supporting information fields should follow GDPR data minimization by collecting only the PII and health-related details needed to evaluate the request.
- If medical information is involved, keep access limited and use the minimum-necessary principle so sensitive details are not broadly exposed.
- The confidentiality acknowledgment helps reinforce that accommodation records should be handled separately from general personnel files.
- If your intake allows anonymous submission, use it only for the initial report path and route identity disclosure through a controlled follow-up step when needed.
General regulatory context for orientation only — verify current requirements with counsel or the relevant agency before relying on this template for compliance.
What's inside this template
Case Overview
This section establishes the case identity, ownership, and confidentiality status so the request can be tracked from the start.
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Case title
Short title for the accommodation case file.
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Case owner
HR representative, accommodation coordinator, or manager responsible for the case file.
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Submission date
Date this case file entry is created.
- Request type
- Case status
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Confidentiality acknowledgment
Confirm that this case file may contain sensitive PII and should be handled on a need-to-know basis.
Employee and Role Information
This section ties the request to the employee’s actual role and essential job functions, which is critical for evaluating feasibility.
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Employee name
Employee name for case tracking.
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Employee ID
Optional internal identifier if your organization uses one.
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Department
Department or business unit.
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Job title
Current job title.
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Work location
Primary worksite, team location, or remote status.
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Essential job functions affected
Describe the essential job functions impacted by the barrier or limitation.
Accommodation Request Details
This section captures what the employee needs, what barrier they are facing, and how urgent the request is.
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Request summary
Brief summary of the accommodation requested.
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Barrier or limitation
Describe the workplace barrier, limitation, or access issue prompting the request.
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Requested accommodation type
Select all accommodation categories that apply.
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Requested accommodation details
Additional details about the specific accommodation requested.
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Urgency level
Use only if needed for prioritization.
Supporting Information and Consent
This section records what evidence was provided, whether more information is needed, and whether the employee agreed to review of that information.
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Supporting information received
Indicate whether supporting information has been provided.
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Type of supporting information
Select the types of supporting information in the case file.
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Medical information needed
Check only if medical or health-related information is necessary to evaluate the request.
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Consent to review supporting information
Consent for HR or the designated reviewer to review submitted supporting information for accommodation evaluation.
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Anonymous submission requested
Use only if your process allows anonymous intake for preliminary concerns; accommodation case files typically require identity for follow-up.
Interactive Process Documentation
This section creates the audit trail for the back-and-forth discussion, alternatives considered, and any temporary measures used while the case is open.
- Interactive process started
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Initial contact date
Date the employee or representative first contacted the organization about the request.
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Meeting notes
Document discussions, questions asked, responses, and agreed next steps.
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Alternative accommodations considered
List alternatives discussed during the interactive process.
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Interim measures
Temporary measures implemented while the request is under review.
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Next review date
Date for the next check-in or follow-up.
Decision and Implementation
This section records the outcome, the reason for the decision, who will implement it, and when follow-up is due.
- Decision
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Decision date
Date the decision was made.
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Decision rationale
Document the basis for the decision, including any limitations, alternatives considered, and business justification if applicable.
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Implementation owner
Person or team responsible for implementing the approved accommodation.
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Implementation date
Date the accommodation was implemented or is expected to be implemented.
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Follow-up required
Check if the accommodation needs a follow-up review after implementation.
Employee Review and Acknowledgment
This section confirms the employee had a chance to review the case outcome and add comments before the record is closed.
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Employee acknowledgment
I understand this case file documents the accommodation process and may be used to support HR review and follow-up.
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Additional comments
Optional final comments or clarifications.
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Submitter name
Name of the person submitting this case file entry, if different from the employee.
How to use this template
- Create the case file as soon as an accommodation request is received and assign a single case owner to maintain the record.
- Enter the employee and role details, then identify the essential job functions affected so the review stays tied to the actual work requirements.
- Document the request summary, the barrier or limitation, the requested accommodation type, and any urgency so the interactive process starts with clear facts.
- Record what supporting information was received, whether medical information is needed, and whether the employee consented to review of that information.
- Log each interactive process step, including the initial contact, meeting notes, alternatives considered, interim measures, decision, and implementation date.
- Complete the employee acknowledgment and set the next review date so follow-up actions do not get lost after the case is closed.
Best practices
- Use progressive disclosure so the form shows only the fields needed for the current stage of the case.
- Mark required fields clearly and keep optional fields optional so employees can submit an initial request without friction.
- Document facts, dates, and decisions in the meeting notes instead of opinions or speculation.
- Limit medical and supporting information to what is necessary for the accommodation review under the minimum-necessary principle.
- Record interim measures when a final decision is pending so temporary support is not forgotten.
- Capture who owns implementation and follow-up so the approved accommodation is actually put in place.
- Use a date picker for dates and structured fields for status and request type to keep the audit trail clean.
What this template typically catches
Issues teams running this template most often surface in practice:
Common use cases
Frequently asked questions
What is this template used for?
This template is used to document an employee accommodation request from intake through decision and follow-up. It captures the request, the barrier or limitation, supporting information, interactive process notes, and the final outcome. It is meant to create a clear case file, not to replace legal review or a separate medical record.
Who should complete the case file?
An HR case owner, ADA coordinator, or other designated manager of the interactive process should complete it. The employee may provide some fields through a form, but the case file should be maintained by the person responsible for tracking the request. If your organization uses a shared workflow, assign one owner so the record stays consistent.
When should this form be used?
Use it as soon as an accommodation request is received, even if the request is informal or incomplete. It is also useful when the employee asks for an interim measure while the full review is underway. Do not wait until a final decision is made, because the interactive process itself should be documented as it happens.
What kind of information should be collected?
Collect only the information needed to evaluate the request and implement any approved accommodation. That usually includes the job functions affected, the barrier, the requested accommodation, any supporting information received, and notes from the interactive process. Avoid collecting unnecessary PII or detailed medical information unless it is genuinely needed for the review.
How does this template support confidentiality?
The case file includes a confidentiality acknowledgment and fields for consent to review supporting information. That helps separate the accommodation record from general personnel files and reminds reviewers to limit access to those who need it. If your process allows anonymous submission for initial intake, this template can capture that request before identity is disclosed more broadly.
What are common mistakes when using an accommodation case file?
Common mistakes include skipping the interactive process notes, documenting opinions instead of facts, and failing to record why an alternative accommodation was rejected. Another frequent issue is treating every field as required, which can discourage early reporting. The template works best when it uses progressive disclosure and keeps sensitive details limited to what is necessary.
Can this template be customized for different roles or locations?
Yes. You can tailor the essential job functions section for specific roles, add location-specific implementation steps, or adjust the decision fields to match your approval workflow. If your organization has multiple sites or union rules, add conditional logic so only the relevant fields appear for each case.
How does this compare with ad hoc email tracking?
Ad hoc email threads make it hard to see the full history, which accommodation was requested, what alternatives were considered, and who approved the final decision. This template creates a single audit trail with consistent fields and review dates. That makes it easier to follow the process, hand off cases, and avoid missed follow-up.
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