ADA Accommodation Request Form
Collect ADA accommodation requests in one place so HR can document the need, review essential job functions, and move the interactive process forward with less back-and-forth.
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Overview
The ADA Accommodation Request Form is designed to capture the information HR needs when an employee asks for a workplace accommodation tied to a disability-related limitation. It organizes the request into clear sections: employee details, the workplace barrier, the essential job functions affected, the accommodation being requested, any supporting documentation, and preferences for the interactive process. That structure helps HR document the request consistently and move from intake to review without relying on scattered email threads.
Use this template when an employee needs a change to schedule, equipment, communication method, workspace setup, job duties, or another work condition that may help them perform the role. It is especially useful when multiple people need to coordinate, such as HR, a manager, and an occupational health or leave specialist. The form also helps when a request is temporary and time-sensitive, because it gives the team a place to note urgency and interim support.
Do not use this form as a substitute for legal advice or as a place to collect unnecessary medical detail. It is not meant for general employee complaints, performance issues, or informal preference requests that are unrelated to a disability-related need. If your organization already has a separate leave, ergonomics, or safety intake process, this form should complement it rather than duplicate it.
Standards & compliance context
- This form supports ADA interactive process documentation by capturing the request, the work-related limitation, and the accommodation being considered.
- Limit medical questions to information that is necessary to evaluate the request and keep any medical documentation separate from general personnel records where required by policy.
- Use consistent review criteria across employees to reduce the risk of uneven treatment or delayed response to accommodation requests.
- If your organization operates in multiple jurisdictions, align the workflow with any additional disability accommodation, privacy, or leave requirements that apply locally.
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
Employee Information
This section identifies the employee and the work context so HR can route the request to the right manager and record it against the correct role.
- Employee Name
- Employee ID
- Job Title
- Department
- Work Location
- Preferred Contact Method
Accommodation Request
This section captures the core of the request, including the barrier, affected job functions, and the accommodation being sought.
-
Accommodation Requested
Briefly describe the accommodation you are requesting.
-
Workplace Barrier or Limitation
Describe the job task, workplace condition, or barrier that is making accommodation necessary.
-
Essential Job Functions Affected
Identify the essential functions of your job that are affected by the limitation.
- Type of Accommodation Requested
- Requested Start Date
- Is this request temporary or ongoing?
Medical Documentation
This section helps HR track whether supporting documentation was provided and whether more information is needed to evaluate the request.
- Supporting Documentation Attached?
- Type of Documentation
-
Documentation Notes
Add any notes about the documentation you are submitting or plan to submit.
- Do you need help obtaining documentation?
Interactive Process Preferences
This section records how the employee wants to meet and communicate so the interactive process is accessible and efficient.
- Preferred Meeting Format
-
Communication Accommodations Needed
Describe any communication format or accessibility needs for the review process.
-
Alternative Accommodations Considered
List any alternative accommodations you would be willing to consider.
- Is there an urgent need for this request?
Employee Certification
This section confirms that the employee reviewed the request and attests that the information provided is accurate to the best of their knowledge.
- Certification
- Employee Signature
- Date
How to use this template
- 1. Set up the form with your organization’s HR contact, privacy language, and the minimum fields needed to evaluate an accommodation request.
- 2. Ask the employee to describe the workplace barrier, the essential functions affected, and the accommodation they believe would help.
- 3. Route the submission to HR and the appropriate manager or specialist so the interactive process can begin without delay.
- 4. Review any documentation provided, confirm whether additional support is needed, and document follow-up questions or meeting preferences.
- 5. Record the decision, interim measures, and implementation details, then revisit the request if the employee’s role or needs change.
Best practices
- Ask for the work limitation and barrier first, then collect supporting documentation only if it is needed for review.
- Keep the essential functions field tied to the actual job description so the review focuses on what the role requires.
- Offer multiple contact and meeting options so employees can participate in the interactive process in a way that works for them.
- Separate medical notes from general HR workflow access so only authorized reviewers can see sensitive information.
- Use the temporary-or-permanent field to trigger different follow-up timelines and avoid letting short-term accommodations lapse.
- Document interim accommodations when a final decision is still pending so the employee is not left without support.
- Standardize how managers escalate requests so informal side conversations do not replace the formal review process.
What this template typically catches
Issues teams running this template most often surface in practice:
Common use cases
Frequently asked questions
What is this form used for?
This form collects the details HR needs to start and document an ADA accommodation request. It helps the employee describe the workplace barrier, the job functions affected, and the type of accommodation being requested. It also gives HR a place to track documentation and next steps in the interactive process.
How often should employees use it?
Employees should submit it whenever they need a new accommodation, a change to an existing accommodation, or a review of an accommodation that is no longer working. It can also be used when a temporary condition requires short-term support. For ongoing needs, the form should be updated if the job, location, or limitations change.
Who should run the review process?
HR usually owns intake and coordination, while the employee’s manager may help confirm essential job functions and operational constraints. In many organizations, legal, leave administration, or occupational health may also be involved depending on the request. The key is to keep the process consistent and limit access to sensitive medical information.
Does this form replace medical certification or doctor notes?
No. The form can capture whether documentation was provided and what type it is, but it does not replace the organization’s documentation review process. Employers should request only the information needed to evaluate the accommodation and should avoid collecting unnecessary medical detail. The exact documentation standard should match company policy and applicable law.
What are common mistakes when using an accommodation request form?
A common mistake is asking for a diagnosis instead of focusing on the work-related limitation and needed support. Another is failing to document the essential functions affected, which makes it harder to evaluate options. Delays, vague follow-up notes, and inconsistent handling across employees can also create problems.
Can this form be customized for different departments or roles?
Yes. You can tailor the job function section, add department-specific workflow notes, or include fields for equipment, schedule, remote work, or accessibility needs. Some organizations also add routing fields for HR, legal, or manager review. Keep the core intake fields stable so requests are handled consistently.
What tools should it integrate with?
It works well with HRIS platforms, case management tools, ticketing systems, and secure document storage. You may also connect it to calendar tools for scheduling interactive process meetings and to workflow automation for routing approvals. If you store medical documentation separately, use access controls and retention rules that match your policy.
How should we roll it out to managers and employees?
Start by explaining when to use the form, who receives it, and how privacy is protected. Train managers to route requests promptly instead of trying to solve them informally. Then publish a simple process guide so employees know what information to provide and what happens after submission.
How is this better than handling requests by email or chat?
Email and chat make it easy to miss key details, lose context, or create inconsistent records. A structured form captures the same information every time, which helps HR compare requests fairly and document decisions. It also reduces follow-up questions because the employee can explain the barrier, the job impact, and the preferred accommodation in one place.
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