Accommodation Request Form
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Accommodation Request Form
Form · FORM-31509
- Version 1
- Miscellaneous
- Reads on any phone
Use this form when a worker asks for an adjustment to the way or place they work. It covers work schedule changes, environmental changes, special equipment or software, physical workspace modifications and help with work-related tasks.
The worker gives their details, ticks the accommodation they need, says why, and states whether it is permanent or temporary and whether supporting documents are attached. They then sign a declaration, and an office-use section records who received and approved the request.
Written by SafetyDocs safety experts, who have been writing safety documents since 2004.
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What it covers
14 fields
- Full Name
- Worker ID
- Department
- Position/Title
- Phone
- If temporary, please specify the duration
- Type of Documentation
- If no documentation is attached, please explain why
- Worker Signature
- Date
- Received by
and 2 more
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