Archive
By Robert Hall
Apr. 1, 2000
This form is used to note what options the employer considered, what they were able to do/not do, and what the employer reasons were for their decision.
CONFIDENTIAL INFORMATION, ACCESS LIMITED TO:
ACCOMMODATION CONSIDERATION / SELECTION
When an individual with a disability is qualified to perform the essential functions, except for functions that cannot be performed because of related limitations and existing job barriers, the employer must try to find a reasonable accommodation to reduce or eliminate these barriers. EEOC TAM 3.2
Applicant / Employee Name:
Reason for Accommodation:
Job Related Limitation:
Direct Threat:
Existing Barrier(s):
An employer should always consult the person with the disability as the first step in considering accommodation. EEOC TAM 3.7
Accommodation(s) Suggested by and/or Discussed with Applicant / Employee:
1. | |
2. | |
3. | |
4. |
If consultation does not identify an appropriate accommodation, technical assistance is suggested. EEOC TAM 3.11(4b)
Internal/External Resource(s) Consulted | Date | Outcome | |
1. | |||
2. | |||
3. | |||
4. |
Accommodation(s) Considered: | Cost | Source | |
1. | |||
2. | |||
3. | |||
4. |
Effective Accommodation(s) Considered Reasonable:
1. | |
2. | |
3. |
The employer is free to choose among effective accommodations; however the individual’s preference should be considered – all things being equal. The accommodation selected should best serve the needs of the individual and the employer. EEOC TAM 3.8(4). The accommodation need not be the best available as long as it is effective. EEOC TAM 3.4
Selected Accommodation: | |
Total Cost: | |
Rationale for Selection: |
|
Financial Assistance Obtained: (Specify amount next to source) (EEOC TAM 3.11)
Tax Credit for Small Business: | |
Tax Deduction/Barrier Removal: | |
Targeted Tax Credit: | |
Applicant/Employee: | |
Insurance: (Identify type): | |
Other: (Identify source) | |
Net Cost:(Total cost, less amount received from other sources): |
Is this accommodation part of a Vocational Rehabilitation Plan? Yes or No
Accommodation device(s) or equipment is owned by:
Employee ___ Employer ___ Insurance Company ___
Other:
If other, please specify:___________________________________________
An individual is not required to accept an accommodation; however, if the individual refuses an accommodation necessary to perform essential job functions and as a result cannot perform those functions, the individual may not be considered qualified.
EEOC TAM 3.8 (III-II)
Applicant / Employee Rejected Accommodation: | |
Reason(s) Given: |
|
Completed By:
Signature _________________________________________
Title_________________________________________
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