Disability Accommodation Interactive Process Documentation Form
Use this form to document the interactive process for a disability accommodation request. Do not include sensitive medical or financial information.
Employee/Requestor Name
*
First Name
Last Name
Department or Team
*
Job Title/Role
*
Date of Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Contact Method
*
Please Select
Email
Phone
In-person
Other
Description of Accommodation Request
*
Functional Limitations or Work Barriers (general terms only)
*
Accommodation Options Discussed
*
Interim Measures or Temporary Accommodations
Final Outcome or Next Steps
*
Submit
Should be Empty: