Workplace Accommodation Follow-Up Form

Workplace Accommodation Follow-Up Form — Form Fields

This hr template includes 10 fields. Collect follow-up information from employees with active accommodations to assess whether current measures remain effective. Free to customize and use on ZenBuild.

• Employee Name (text, required)
• Work Email (email, required)
• Department (text, required)
• Original Accommodation Approved (text, required)
• Date Accommodation Was Implemented (text, required)
• How effective has your current accommodation been? (1=not effective, 5=very effective) (rating, required)
• Is your current accommodation still meeting your needs? (multiple choice, required) — options: Yes - fully, Yes - partially, No
• If partially or not meeting needs, please describe what is lacking (long text, optional)
• Are you requesting a modification to your accommodation? (multiple choice, required) — options: Yes, No
• Describe the requested modification (long text, optional)