Accommodation Request Form

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.