Workplace Accommodation Request Form

Workplace Accommodation Request Form — Form Fields

This hr template includes 7 fields. Enable employees to formally request workplace accommodations for medical, disability, or accessibility needs. Free to customize and use on ZenBuild.

• Employee Full Name (text, required)
• Work Email Address (email, required)
• Job Title (text, required)
• Type of Accommodation Needed (dropdown selection, required) — options: Physical/Ergonomic, Schedule Modification, Remote Work, Assistive Technology, Other
• Description of Accommodation Needed (long text, required)
• Do you have supporting medical documentation? (multiple choice, required) — options: Yes, I can provide documentation, No, I do not have documentation, I will obtain documentation
• Upload Supporting Documentation (Optional) (file upload, optional)