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Reasonable Adjustment Request form

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Our Reasonable Adjustment Request Form Template enables employees to request accommodations, ensuring inclusivity and compliance with disability regulations.

Reading time
How long to understand and implement this form?
5 mins
Word count
How many words in this form?
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What is a Reasonable Adjustment Request form?

The Reasonable Adjustment Request Form allows employees to formally request accommodations or modifications to their work environment, tasks, or procedures to accommodate their specific needs or disabilities. It provides a structured process for employees to communicate their requirements, enabling employers to consider and implement appropriate adjustments to support their inclusion and participation in the workplace.

This form promotes inclusivity and equal opportunities by facilitating open communication between employees and employers regarding reasonable adjustments.

It helps ensure that employees with disabilities or specific needs receive the necessary support to perform their roles effectively and access the same opportunities for career progression as their colleagues.

Best practice timescale for this to be issued
When should this form be issued?
As and when required
Issued by who, to whom
Who should issue this form, and to whom?
The Employee to the Employer (you)
Applicable legal jurisdictions
In which jurisdictions can this form be used?
Great Britain & NI (United Kingdom), Worldwide

What legislation and best practice guidelines have been taken into account in the development of this template?

United Kingdom
  • Equality Act 2010: Mandates employers to make reasonable adjustments for employees with disabilities or health conditions.

  • Data Protection Act 2018 (incorporating GDPR): Dictates the handling of personal data within the reasonable adjustment request form in compliance with data protection principles.

  • Health and Safety at Work Act 1974: Obliges employers to ensure the health, safety, and welfare of employees, which may include making reasonable adjustments.

  • Employment Rights Act 1996: Sets the legal framework for employment contracts and terms, including the provision of reasonable adjustments.

  • Disability Discrimination Act 1995 (DDA): Though repealed, previous versions of the DDA established obligations similar to those in the Equality Act regarding reasonable adjustments for disabled employees.

Other territories

Consult your jurisdiction's employment legislation or labor laws to ensure compliance with the template. Review the language for local precision.

Reasonable Adjustment Request

Employee Information:

Name: _________________________

Employee ID: ___________________

Department: ____________________

Job Title: _______________________

Contact Details: ________________

Nature of Disability/Condition:

Please describe the disability/condition for which you are requesting reasonable adjustments:

Requested Adjustments:

Please specify the adjustments you are requesting:

Impact on Work:

How does your disability/condition impact your ability to perform your job duties?

Additional Information:

Is there any additional information you would like to provide to support your request?


Employee Signature: _________________________ Date: ____________

Manager/HR Approval:


Not Approved


Signature: _________________________ Date: ____________

Version: [1.0]

Issue date: [date]

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Reasonable Adjustment policy

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Reasonable Adjustment Request form template
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Reasonable Adjustment Assessment Checklist form template

Our Reasonable Adjustment Assessment Checklist Form Template helps evaluate and implement accommodations, ensuring fair treatment and accessibility for employees with disabilities.

Reasonable Adjustment Request form
reasonable adjustment request form