TO: (1) ____________________________
FROM: (2) ____________________________
RE: Request for Reasonable Accommodation
DATE: (3) ________________________
This is a request for reasonable accommodation under the Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA). If you are not the appropriate person to receive this request, please notify me immediately, and forward this letter on to the person who handles requests for reasonable accommodation.
I am a person with a “disability” under the ADA and the FEHA. [My condition is (4) ____________________.] Due to my disability, I need (5) ____________________________________.
According to the ADA and the federal Equal Employment Opportunity Commission (EEOC), providing specialized equipment is a form of reasonable accommodation. See 42 U.S.C. § 12111(9)(B) and EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act (Oct. 17, 2002), both available at www.eeoc.gov.
Please let me know if you require reasonable medical documentation of my condition, or if you wish to propose alternative accommodations to those I have requested. I am available and eager to engage in the interactive process with you.
(1) Name of Human Resources director, supervisor, program director, or another manager
(2) Your name
(3) Today’s date
(4) Optional: State the name or a description of your condition using language you feel comfortable with.
(5) Describe the equipment you need and how it relates to your disability. For example, “a captioned telephone because I am hard of hearing.” or “an ergonomic keyboard to prevent exacerbation of my carpal tunnel.”
Disability-related equipment in the workplace might include: video phone; captioned phone; visual doorbell; text-to-screen software (e.g. JAWS); voice recognition software (e.g Dragon Naturally Speaking); text pager; ergonomic chair; ergonomic keyboard; tracking ball; telephone head set; air filter; space heater; automatic door opener.