Reasonable Adjustment Assessment Checklist form template

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

Why this form is necessary

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.

  • 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.

Workflow sequence

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.


Reading time icon
Time to read / prep / use
5 mins
Document specs icon
Word count / length
253 words, 2 pages A4
Date last reviewed icon
Date last reviewed
1 July 2024
reasonable adjustment assessment checklist form template

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]

Why choose our Reasonable Adjustment Assessment Checklist form template?

Our content:

Is easy to edit and execute, with comprehensive implementation guidance.
Is designed by accredited, experienced HR practitioners.
Maintains your compliance with ACAS guidelines, legislation, and industry best practices.
Includes 12 months access to your purchase, with email alerts if updated or expanded.

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