Faculty and Staff Request for Reasonable Workplace Accommodation Form

Faculty and Staff Request for Reasonable Workplace Accommodation Form

The purpose of this form is to assist the University in determining whether, or to what extent, a reasonable accommodation is required for an employee with a disability to perform one or more essential functions of their job safely and effectively. This form must be filed separately from the employee's personnel file and be treated confidentially.

Based upon CDC guidance, some people may be at higher-risk of experiencing negative COVID-19 outcomes due to their individual circumstances. Faculty/staff who fall within the CDC’s definition of a “vulnerable person” (documented in the Return to Campus Guide) or with a documented disability may request reasonable accommodations to their work environment. For the duration of the pandemic, OIE will review accommodation requests from vulnerable persons in in the same manner it reviews disability accommodations.

A downloadable version of the form can be found here.

1
2
3
4
5
6
7
8
9
0
delete
q
w
e
r
t
y
u
i
o
p
a
s
d
f
g
h
j
k
l
shift
z
x
c
v
b
n
m
!
?
shift
space