ADA Accommodation Request Form for US Employers (Template)

The form is the intake instrument that converts an informal request into a documented, trackable process. Under the ADA, an employee does not need to use magic words or even mention the statute to trigger an employer's duties; a worker who says their back condition makes it hard to sit for eight hours has effectively asked for an accommodation. The form gives that conversation a paper home. It records who made the request, what job function the disability affects, what change the employee proposes, and what the employer ultimately decided and why.

A request form is not the accommodation decision itself, and it is not a medical certification. Those are separate steps. The form opens the file; the interactive process fills it. People often confuse the request form with the medical documentation letter sent to a treating physician, but they do different work. The request form is completed by the employee and the HR reviewer and captures the business side of the analysis: the essential functions, the proposed adjustment, the cost and feasibility assessment. The medical letter, by contrast, goes to a health care provider and asks narrowly about functional limitations. Keeping the two documents distinct matters, because the ADA requires that any medical information be stored separately from the regular personnel file and shared only with people who need it. A form that blends business notes and clinical detail in one place creates a confidentiality problem before the analysis even begins. Our employee write-up and incident form follows the same separation logic for performance records.

The governing statute is the Americans with Disabilities Act of 1990, codified at 42 U.S.C. §12101 and following, as amended by the ADA Amendments Act of 2008. The Amendments Act deliberately broadened the definition of disability, instructing courts to read it in favor of broad coverage, so impairments that older case law brushed aside now routinely qualify. The reasonable accommodation obligation applies to private employers with 15 or more employees, and parallel duties reach federal contractors and recipients of federal funds under the Rehabilitation Act of 1973. The agency that enforces Title I is the Equal Employment Opportunity Commission, and its enforcement guidance is the practical playbook most HR departments follow.

The legal core is the interactive process. Once an employee signals a need, the employer must respond expeditiously and engage in a flexible, good-faith dialogue to identify an effective accommodation. The EEOC has been blunt that ignoring a request or letting it drift can itself violate the ADA, independent of whether the accommodation was ultimately owed. Unreasonable delay is treated as a denial. The employer holds one important prerogative: where several accommodations would work, it may choose among them, so long as the one it picks is genuinely effective at removing the workplace barrier.

Documentation rules deserve close attention. An employer may request reasonable medical documentation only when the disability or the need for accommodation is not obvious, and only enough to establish the ADA disability and the link to the requested change. Asking for a complete medical history crosses the line, because full records sweep in information unrelated to the request. The EEOC's Enforcement Guidance on Reasonable Accommodation and Undue Hardship spells out what "sufficient" documentation looks like: the nature, severity, and duration of the impairment, what it limits, and why the specific accommodation answers that limit. Employers who want the authoritative source should read the EEOC enforcement guidance on reasonable accommodation and undue hardship under the ADA before finalizing any internal policy.

The most common trigger is an employee who tells a supervisor that some part of the job has become hard because of a health condition. A warehouse worker who mentions a lifting restriction, an analyst who asks for a quieter desk because of a concentration disorder, a receptionist who needs an adjusted start time for dialysis: none of them has to file anything formal to start the clock. The form exists precisely so the manager who hears that comment has a clean way to route it to HR instead of making an on-the-spot promise or, worse, brushing it off. The duty to engage begins at the request, not at the paperwork.

A second scenario is the leave request that turns into an accommodation question. When an employee asks for time off for a medical condition and the leave cannot be handled under the FMLA, workers' compensation, or your own PTO program, the ADA may require you to treat additional leave as a reasonable accommodation. The form captures that pivot so the file shows you considered it rather than defaulting to a denial. Our state-compliant PTO policy template pairs naturally with this analysis, since the two programs often overlap.

You also need the form during return-to-work and reassignment situations. An employee coming back from surgery with permanent restrictions, or one whose role has changed in a way their condition no longer fits, both fall inside the accommodation framework. One edge case worth flagging: a request can come from a manager's own observation, not just the employee's words, when a known impairment plainly interferes with work, and a savvy employer documents that it offered the process rather than waiting to be asked. Another underappreciated trigger is the recurring informal arrangement, where a supervisor has quietly let someone leave early for months; once that becomes contested, you want a dated record showing the accommodation was evaluated, not improvised.

• The requesting employee and position section identifies the worker, the job title, and the essential functions of that role as the employer understands them. Pinning down essential functions early matters because the entire analysis turns on whether the accommodation lets the employee perform them, and a vague job description weakens every step that follows.
• The description of the limitation asks the employee to explain, in plain language, which work activities the condition affects, without forcing a diagnosis into the file. This mirrors the EEOC's position that the employer needs to understand the functional barrier, not the clinical label, to evaluate the request properly.
• The requested accommodation field records what the employee is proposing, whether a schedule change, equipment, a modified workspace, reassignment, or leave. It leaves room for the employer to note alternative accommodations considered, which preserves the statutory right to choose among effective options.
• The medical documentation tracker logs whether documentation was requested, what was received, and the date, while keeping the substance in a separate confidential file. It is a pointer, not a repository, so the request form itself stays free of protected health information.
• The interactive process log captures each meeting, call, and email by date, building the contemporaneous record that defeats a claim the employer stonewalled. Our employee handbook template cross-references this log so your written policy and your case file stay consistent.
• The employer determination and undue-hardship analysis documents the decision, the reasoning, and any cost or operational factors weighed. A denial recorded with specifics holds up far better than a one-line refusal.

The first and costliest error is treating silence as a safe response. Employers often sit on a request while they "look into it," and the EEOC reads unnecessary delay as a denial in its own right. A manager who receives a request and does nothing for six weeks has already exposed the company, even if the accommodation would eventually have been granted. The fix is procedural: route every request to a named coordinator the day it lands, and start the log immediately. A close cousin of this mistake is letting front-line supervisors deny requests on their own authority, when they lack the training to assess essential functions or undue hardship.

The second cluster of mistakes involves medical information. Over-collecting is the classic trap, where an employer demands full medical records or a diagnosis it does not need, which itself can violate the ADA. Equally damaging is sloppy storage, dropping a doctor's note into the regular personnel file where any manager can see it; the statute requires that medical material live in a separate, access-restricted file. A third recurring failure is the unwritten accommodation, where everyone agrees verbally and no one records it, so when a new manager arrives or the arrangement is challenged, there is nothing to show the process happened. Finally, employers forget that accommodation is ongoing, not one-and-done; a condition that worsens or a job that changes can reopen the duty, and a form filed once does not close the file forever. Your non-compete and non-solicitation agreement and related restrictive documents should never be used to discourage a worker from raising an accommodation need.

You begin by entering the employee's details and the position involved, then describing the essential functions of that job as your organization defines them. From there, the form prompts the employee to explain the limitation in functional terms, what the condition makes difficult at work, rather than supplying a medical diagnosis. The next field captures the accommodation the employee is requesting, with space for the reviewer to record alternatives the employer wants to explore during the dialogue.

The middle of the form walks you through the documentation question: whether the disability or need is obvious, and if not, what reasonable medical information you are requesting and when it arrives. You then log each interaction in the interactive-process section, dating every meeting and message so the record builds itself as the conversation unfolds. The form closes with the employer's determination, where you document the decision, the reasoning, any undue-hardship factors, and the effective date of any approved accommodation. Throughout, the template keeps the business analysis and the confidential medical notes in separate sections, so you can store them in different files the way the law requires. Once complete, you download it in Word for internal editing or PDF for the signed record, and you can browse the full US employment document library for the companion forms.