Reasonable Adjustment Assessment Checklist form template

£ 15

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

Reading time
How long to understand and prepare this form?
5 mins
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reasonable adjustment assessment checklist form template

What is a Reasonable Adjustment Assessment Checklist form?

The Reasonable Adjustment Assessment Checklist Form is a tool used to evaluate and document the feasibility and effectiveness of reasonable adjustments requested by employees with disabilities or specific needs. It enables employers to assess the impact of proposed adjustments on job performance, feasibility of implementation, and compliance with legal requirements.

This form serves as a systematic approach to assessing reasonable adjustment requests, ensuring that employers can make informed decisions and provide appropriate accommodations to support employees in the workplace.

By documenting the assessment process, it promotes transparency and accountability, helping to create an inclusive work environment where all employees can thrive.

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 Employer (you) to the Employee
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 to ensure they are not disadvantaged.

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

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

  • Agency Workers Regulations 2010: Employers engaging agency workers may need to consider reasonable adjustments under these regulations.

  • Occupational Health and Safety Regulations: May contain provisions or guidelines related to making reasonable adjustments to ensure workplace safety.

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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 Assessment Checklist

Employee Details:

Employee ID:  
Job Title:   

Nature of Disability/Condition:

Describe the employee's disability/condition for which reasonable adjustments are being considered:


Requested Adjustments:

List the requested adjustments proposed by the employee:


Assessment Criteria:

Consider the following factors when assessing the feasibility and effectiveness of the requested adjustments:

  1. Impact on Job Performance:

    • How does the disability/condition affect the employee's ability to perform job duties?
    • Will the proposed adjustments address these challenges effectively?
  2. Feasibility:

    • Are the requested adjustments reasonable and practicable for the organisation to implement?
    • Are there any logistical or financial constraints to consider?
  3. Legal Compliance:

    • Do the proposed adjustments comply with relevant anti-discrimination legislation and company policies?
    • Will the adjustments ensure equal opportunities for the employee?


Based on the assessment, provide recommendations regarding the approval and implementation of the requested adjustments:

Approved:  Yes | No
Additional adjustments or alternatives recommended (if applicable):  


Reviewer's Name: Yes | No Reviewer's Signature:   Date:  

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Version: [1.0]

Issue date: [date]

What communication / process sequence is this part of?

Previous step
Reasonable Adjustment Request form template

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

This step
Reasonable Adjustment Assessment Checklist form template
Next step
Reasonable Adjustment Plan template

Our Reasonable Adjustment Plan template facilitates fair accommodations, ensuring inclusivity and compliance with disability regulations for employees.

Why buy our Reasonable Adjustment Assessment Checklist 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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