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 state and federal laws. [My condition is (4) ___________________________.] Due to my disability, (5) _______________________________________.
According to the ADA and the federal Equal Employment Opportunity Commission (EEOC), job restructuring is a form of reasonable accommodation. See 42 U.S.C. § 12111(9)(B) and the sections entitled “Reasonable Accommodation” and “Job Restructuring” in EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act, 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 ready and willing to engage in the interactive process with you so that I may continue in my employment.
(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) Specifically explain the change that you need and why. Examples:
“Because I am hard of hearing, I have difficulty understanding strangers on the phone. I would like to be excused from answering the phone, which I do not understand to be a core function of my job. I am willing to take on a different task as needed.”
“I am often fatigued in the afternoon. I would like to switch the order in which I perform my duties, so that I perform my physical tasks (unpacking boxes) in the morning and my sedentary tasks (data entry) in the afternoon.”
“I am part of a three-person painting crew that is sent out to prepare and paint interiors. Because of my seizure disorder, I would like to be excused from the ladder work. The other people on my crew are available to work on the ladder, and I can do any other prep and finish work.”
Note: You must still be considered “qualified” to perform the basic duties of your job or another vacant position.