Reasonable Adjustment Request form template

£ 15

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 prepare this form?
5 mins
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reasonable adjustment request form template

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 or best practices underpin this template / should I be aware of?

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  • Disability Discrimination Act 1995 (DDA): Though repealed, previous versions of the DDA established obligations similar to those in the Equality Act regarding reasonable adjustments for disabled employees.

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Other territories

Refer to your local employment legislation / labor laws to support the execution of the template. Review the wording for local accuracy.

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: ____________

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Version: [1.0]

Issue date: [date]

What communication / process sequence is this part of?

Previous step
Reasonable Adjustment policy

Use this if you require a robust and practical Reasonable Adjustment policy template.

This step
Reasonable Adjustment Request form template
Next step
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.

Why buy our Reasonable Adjustment Request form template?

  • It's easily editable and implementable, saving you time and money
  • It's designed by CIPD accedited Chartered HR practitioners with operational experience in this area
  • You will maintain compliance with ACAS guidelines, legislation, and industry best practices
What other advantages does buying from offer?
  • Email notifications for any updates made to this template or its accompanying materials
  • 12 months of unrestricted access without any additional costs (any update in that period is free to you)
  • A 25% discount on all library, toolkit, and template purchases/renewals

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