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Confidential Request for Medical Information - Employee - DHR EO 14A <br />Page 3 of 4 <br />If the impairment is episodic in nature, does it substantially limit a major life <br />activity or bodily function when it occurs? o Yes o No <br />Reasonable accommodations are modifications or adjustments to the work <br />environment or to the manner or circumstances under which the position held is <br />customarily performed that enable an individual with a disability to perform the <br />essential functions of the position. Under the Americans with Disabilities Act, an <br />employee with a disability is entitled to an accommodation only when the <br />accommodation is needed because of a disability and the accommodation <br />does not create an undue hardship. <br />The employee is currently working in the position of <br />The essential job functions of this position are: (List all essential job functions). <br />The employee is having trouble performing the following essential job functions <br />because of the limitation(s) the employee is experiencing: <br />How does the employee's limitation interfere with his/her ability to perform the <br />job function(s)? <br />Do you have any suggestions regarding possible accommodations to improve <br />job performance? If yes, what are they? <br />How would your suggestions improve the employee's job performance? <br />