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ADA Reasonable Accommodation Request

ADA Title I accommodation request — initiates interactive process per EEOC.

Start free — included with every suite See it in MangoApps

14 days free, $0 today — Forms comes with every suite.

Rolled out to every employee at AutoZone (125,000), PetSmart (50,000+), A.S. Watson and Raley's (20,000) — and at larger retailers we are not permitted to name.

What's inside this template

Employee

  • Employee name (required)
  • Job title (required)
  • Department / manager (required)

Accommodation Needed

  • What functions / job duties are difficult to perform? (required)
  • What accommodation are you requesting? (required)

    Be specific — e.g., raised desk, schedule modification, screen reader, etc.

  • When did you become aware of the need?

Documentation

  • Healthcare provider statement attached?

    May be required for non-obvious disabilities

  • Healthcare provider documentation

Sign-Off

  • Employee signature (required)
  • Date submitted (required)

Common use cases

Disability accommodation request
Interactive process initiation

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Ready to use this template?

ADA Reasonable Accommodation Request runs on a platform app included with every MangoApps plan — pick a suite and it comes along.

Start free — included with every suite

Rolled out to every employee at AutoZone (125,000), PetSmart (50,000+), A.S. Watson and Raley's (20,000) — and at larger retailers we are not permitted to name.