ADA Reasonable Accommodation Request
Use this ADA Reasonable Accommodation Request form to start the interactive process, document the workplace barrier, and capture only the information needed to review the request.
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Overview
This ADA Reasonable Accommodation Request template is the intake form used to start the interactive process between an employee and employer. It captures who is making the request, what workplace barrier they are experiencing, which essential job functions are affected, whether the accommodation is temporary or permanent, and what supporting documentation is available.
Use this form when an employee needs a change to the work environment, schedule, tools, or duties because of a disability-related limitation. It is especially useful when HR needs a consistent record for routing, follow-up, and confidentiality handling. The template also helps reduce back-and-forth by prompting for the minimum information needed to evaluate the request and by separating employee details from supporting documentation.
Do not use this form as a general health intake, a disciplinary record, or a broad medical questionnaire. It is also not the right tool for unrelated leave requests unless they are part of an accommodation review. If your process does not require medical documentation for a given request, keep that field optional and use conditional logic so employees are not asked for unnecessary PII. The form should end with a clear submission-confirmation line so the employee knows what happens next and who will review the request.
Standards & compliance context
- This template supports ADA Title I accommodation intake by documenting the request and beginning the interactive process.
- The form should follow GDPR data minimization principles by collecting only the PII and supporting information needed to evaluate the request.
- If medical information is collected, limit access and retention to the minimum necessary for the accommodation review process.
- Confidentiality acknowledgement and controlled document access help support internal privacy handling and audit trail expectations.
- For public-facing or employee-accessible forms, design fields and labels to meet WCAG 2.1 AA accessibility expectations.
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 requester and routes the form to the right HR owner without collecting unnecessary personal details.
- Employee name
-
Employee ID
Optional if your organization uses employee IDs for routing.
- Work email
- Department
- Manager name
Accommodation Request
This section captures the actual barrier, the affected job duties, and whether the accommodation is temporary or permanent.
- What are you requesting?
-
Describe the accommodation you are requesting
Explain what adjustment would help you perform the essential functions of your job.
-
What workplace barrier or limitation is this request meant to address?
Describe the work-related difficulty without sharing more medical detail than necessary.
-
Which essential job functions are affected?
Select all that apply.
- Is this request temporary or ongoing?
Supporting Information
This section records whether documentation exists and keeps uploads limited to what is needed for the review.
- Are you submitting supporting documentation?
-
Upload supporting documentation
Optional. Upload only documents relevant to the accommodation request.
-
Additional context
Optional. Share any other information that would help HR understand the request.
Consent and Review
This section documents confidentiality acknowledgement, permission to start the interactive process, and the employee’s submission record.
- I understand this form may include PII or medical information and will be handled confidentially to the extent required by law.
- I consent to HR contacting me to discuss this request and participate in the interactive process.
- Employee signature
- Submission date
How to use this template
- 1. Configure the employee information fields, mark required vs optional clearly, and connect work_email and department to your HR record if you want to prefill known data.
- 2. Set up the accommodation request section with field types that match the data, using a multi-select or dropdown for request_type and a short text field for the workplace barrier.
- 3. Add conditional logic so medical_documentation_provided and documentation_files appear only when documentation is needed, and keep the upload field limited to authorized reviewers.
- 4. Route submissions to HR or the accommodation coordinator, then review the essential_functions_affected field with the employee and manager to confirm the job duties involved.
- 5. Record any follow-up questions, update the interactive process notes, and close the loop with a clear decision, next step, or temporary accommodation timeline.
Best practices
- Keep the form focused on the barrier and the job impact, not on a full medical history.
- Use progressive disclosure so documentation fields appear only when they are needed for review.
- Mark required fields sparingly and explain why each required field is necessary.
- Use a date field for submission_date and a signature field for employee_signature instead of free text.
- Limit access to documentation_files to authorized HR reviewers and preserve an audit trail.
- Include a clear line that explains what happens after submission, including who reviews the request and whether follow-up may be needed.
- Tailor request_type options to the accommodations your organization actually supports so employees are not forced into an inaccurate choice.
What this template typically catches
Issues teams running this template most often surface in practice:
Common use cases
Frequently asked questions
Who should use this ADA reasonable accommodation request form?
Use it when an employee needs a change to the workplace, schedule, tools, or duties because of a disability-related limitation. It is designed for HR, managers, and employees to begin the interactive process with a clear record of the request. It is not a general complaint form or a performance review form.
What kinds of accommodations does this template cover?
It covers requests for changes such as modified schedules, accessible equipment, workstation adjustments, remote-work considerations, leave-related adjustments, and other job-related accommodations. The form captures the barrier, the essential functions affected, and whether the request is temporary or permanent. That makes it easier to route the request to the right reviewer.
How often is this form used?
It is typically used whenever an employee initiates a new request or needs to update an existing one. Some employers also reuse it for renewals when a temporary accommodation expires or when job duties change. The form should support repeat submissions without forcing the employee to restate unrelated history.
Who should review and process the request?
HR or an accommodation coordinator should usually own intake, with manager input only as needed for essential functions and feasibility. Medical details should be limited to the people who need them to evaluate the request. The form should create an audit trail of who received the request and when.
What should we avoid collecting on this form?
Collect only the minimum necessary PII and supporting information needed to evaluate the accommodation. Avoid asking for diagnosis details unless they are truly needed, and do not collect unrelated medical history. If documentation is optional or only needed in some cases, use conditional logic so the form does not over-collect.
How does this form support confidentiality and compliance?
The consent and review section can capture confidentiality acknowledgement and permission to begin the interactive process. That helps document the employee’s understanding that the request will be reviewed by authorized personnel only. It also supports a cleaner record for ADA-related handling and internal audit purposes.
What are common mistakes when using this template?
Common mistakes include making every field required, asking for free-text where a date picker or multi-select would be better, and failing to explain what happens after submission. Another pitfall is skipping the essential-functions field, which makes it harder to evaluate whether the request is job-related. The template should also avoid forcing employees to upload medical files unless they are actually needed.
Can this template be customized for different roles or departments?
Yes. You can tailor the request options, add department-specific essential functions, and adjust the supporting documentation field based on your review process. For example, a warehouse role may need different prompts than a desk-based role, while still using the same core intake structure.
How should this form fit into our HR systems?
It works well when connected to HR case management, secure file storage, and an internal workflow for routing approvals or follow-up questions. Integrations should preserve confidentiality and the audit trail while limiting access to authorized reviewers. If you use e-signature or ticketing tools, keep the employee signature and submission date as part of the record.
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