MEMORANDUM
TO: (1) ____________________________
FROM: (2) ____________________________
RE: Request for Reasonable Accommodation
DATE: (3) ____________________________
This is a request for reasonable accommodation under the 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 requesting an accommodation for a condition related to pregnancy on the advice of my health care provider. Due to my pregnancy, (4) _______________________________________.
It is unlawful “for an employer to refuse to provide reasonable accommodation for an employee for conditions related to pregnancy… if she so requests, with the advice of her health care provider.” Cal. Gov. Code § 12945(b)(1). It is unlawful for an employer to place a pregnant employee on leave because of pregnancy when she has not requested leave. 2 Cal. Code Regs. § 11039(a)(H).
Job restructuring is a form of reasonable accommodation. See Cal. Code Regs. tit. 2, § 11035 (s) (citing examples of modifying work duties, schedules, furniture, and break time).
Please let me know if you require reasonable medical documentation of my condition. I am ready and willing to engage in the interactive process with you so that I may continue in my employment.
Thank you.
(1) Name of Human Resources director, supervisor, program director, or another manager
(2) Your name
(3) Today’s date
(4) Specifically explain the change that you need and why. Examples:
“Because I am pregnant, my doctor has advised me to refrain from lifting items over fifteen pounds.”
“I am often fatigued and nauseous in the morning as a result of my pregnancy. I would like to switch the order in which I perform my duties, so that I perform my physical tasks (unpacking boxes) in the afternoon and my sedentary tasks (data entry) in the morning.”
“I am part of a three-person painting crew. Because of my pregnancy and the risk to myself and my child if I fall, I would like to be excused from ladder work. Other crew members are available for ladder work, and I can do any other prep and finish work.”
“Because I am pregnant, I must stay hydrated throughout the day. As a result I would like to carry a small water bottle with me on the retail floor and be excused for frequent bathroom breaks.”