HomeMy WebLinkAboutReasonable Accom Proc Form AmendedDivision:
Equal Opportunity
Effective Date:
March 11, 2009
Amended:
July 31, 2018
July 20, 2017
May 10, 2011
Subject:
Procedures for Providing Reasonable Accommodation for
Individuals with Disabilities
References:
Title I of the Americans with Disabilities Act of 1990, (ADA);
The Americans with Disabilities Act Amendments Act of 2008,
(ADAAA)
Purpose:
To provide procedures for receipt, consideration, and
processing of requests for reasonable accommodation from
employees and job applicants
POLICY
The "Anti -Discrimination and Harassment Policy" ("Policy") effective
October 1, 2005, and amended April 13, 2007, October 17, 2007,
February 9, 2010, February 8, 2012, and March 1, 2015 is incorporated
herein by reference.
BACKGROUND
Discrimination and harassment based on disability violate the County of
Hawai'i's Anti -Discrimination and Harassment Policy effective October 1,
2005, as amended, and federal and state civil rights laws.
APPLICABILITY
The Reasonable Accommodation Procedures apply to all employees and
job applicants.
DEFINITIONS
"Accommodation file" means a confidential and secure file which
contains documentation of the accommodation process. This includes all
documentation relating to the request for reasonable accommodation.
"Accommodation Resource Manager" (ARM) means the departmental
designate who provides assistance, information, and support to decision
makers and employees regarding reasonable accommodation, including
processing requests for additional medical information when needed.'
"ADA Coordinator" means the employee responsible for coordinating the
County's efforts to comply with and carry out its responsibilities under the
Americans with Disabilities Act. The ADA Coordinator's duties are
assigned to the Equal Opportunity Officer/ADA Coordinator in the
Department of Human Resources.
"Assistive technology" means any item, piece of equipment, or system
whether acquired commercially, modified, or customized that is used to
increase, maintain, or improve functional capabilities of individuals with
disabilities. Forms of assistive technology include, but are not limited to,
screen readers which allow persons who cannot see a visual display to
either hear screen content or read the content in Braille, specialized one -
handed keyboards which allow an individual to operate a computer with
only one hand, and specialized audio amplifiers that allow persons with
limited hearing to receive an enhanced audio signal (definition from The
Assistive Technology Act of 1998).
"Auxiliary aids and services" means, but is not limited to:
qualified interpreters, note takers, transcription services, written
materials, telephone handset amplifiers, assistive listening systems,
telephones compatible with hearing aids, closed caption
decoders, open and closed captioning, telecommunications
devices for deaf persons, videotext displays, or other effective
methods of making aurally delivered materials available to
individuals with hearing impairments;
qualified readers, taped texts, audio recordings, Brailled materials,
large print materials, or other effective methods of making visually
delivered materials available to individuals with visual impairments;
and
• acquisition or modification of equipment or devices and other
similar services and actions.
"Decision maker" means the supervisor, manager, or other employee
responsible for deciding whether a request for accommodation is
reasonable and also for implementing it. This includes requests for
accommodation for any aspect of the job application process, training,
participation in a special event, performance of job duties, modifications
to the workplace, and/or access to a benefit of employment.
"Direct threat" means a significant risk of substantial harm to the health or
safety of the individual or others that cannot be eliminated or reduced by
reasonable accommodation.
"Disability" means, with respect to an individual:2
• a physical or mental impairment that substantially limits one or
more of the major life activities of such individual (an impairment
that is episodic or in remission is a disability if it would substantially
limit a major life activity when active);
• a record of such impairment; or
• being regarded as having such an impairment.3
Note: Some impairments virtually always constitute a disability including,
but not limited to, epilepsy, diabetes, cancer, HIV infection, bipolar
disorder, deafness, blindness, intellectual disability (formerly known as
mental retardation), partially or completely missing limbs, autism,
obsessive compulsive disorder, cerebral palsy, multiple sclerosis, muscular
dystrophy, etc.
"Essential functions" mean the fundamental job duties of the employment
position the individual with a disability holds or desires. The term "essential
functions" does not include the marginal functions of the position.4
"Expedited request" means a request for accommodation that must be
processed quickly so the individual with a disability does not lose an
opportunity to participate because the accommodation is delayed, for
example, arranging for a sign language interpreter to sign during an
employment interview for a job applicant who is deaf or arranging a
meeting in an accessible room so an employee with a mobility
impairment can attend.
"Extenuating circumstances" means factors that delay the processing of
an accommodation request that could not have reasonably been
anticipated or avoided in advance of the request for accommodation.
"Interactive process" means a good faith, flexible communication process
between an individual requesting a reasonable accommodation and the
decision maker to determine the appropriate accommodation. Although
this process is described in terms of accommodations that enable the
individual with a disability to perform the essential functions of the position
held or desired, it is equally applicable to accommodations involving the
job application process, training and special events, and to
accommodations that enable the individual with a disability to enjoy
equal benefits and privileges of employment. The interactive process
requires a decision maker to use the following problem -solving approach:
• analyze the particular job involved and determine its purpose and
essential functions;
• consult with the individual with a disability to ascertain the precise
job -related limitations imposed by the individual's impairment(s)
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and how those limitations could be overcome with a reasonable
accommodation;
• in consultation with the individual to be accommodated, identify
potential accommodations and assess the effectiveness of each in
enabling the individual to perform the essential functions of the
position; and
• consider the preference of the individual to be accommodated
and select and implement the accommodation that is most
appropriate for the employee and the employer.5
"Major life activities" means:
• caring for oneself;
• performing manual tasks;
• seeing;
• hearing;
• eating;
• lifting;
• bending;
• twisting;
• speaking;
• breathing;
• learning;
• eliminating bodily waste;
• reading;
• concentrating;
• thinking;
• communicating;
• sleeping;
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• interacting with others;
• working; and
• operation of major bodily functions such as functions of the
immune system, digestive, bowel, bladder, neurological, brain,
respiratory, circulatory, endocrine, hemic, reproductive functions,
and normal cell growth.
This list is not exhaustive.
"Mobility devices" mean devices used by individuals with mobility
impairments for the purposes of locomotion. Mobility devices may be
powered by the individual or some other source.
"Qualified interpreter" means an interpreter who is able, both receptively
and expressively, to interpret effectively, accurately, and impartially using
any necessary specialized vocabulary.
"Priority placement" means referral and placement to a suitable job for
which a County of Hawai'i employee meets the minimum qualification
requirements after it is medically determined that the employee is not
able to perform the essential functions of his/her regular position with or
without a reasonable accommodation.
"Reasonable accommodation" means:
modifications or adjustments to a job application process that
enable an individual with a disability to be considered for the
position such individual desires;
• modifications or adjustments to the work environment or to the
manner or circumstances under which the position held or desired
is customarily performed that enable an individual with a disability
to perform the essential functions of the position; and
• modifications or adjustments that enable an individual with a
disability who is employed to enjoy equal benefits and privileges of
employment which are enjoyed by other similarly situated
employees without disabilities.
A "Reasonable Accommodation" may be directly or indirectly related to
the individual's disability. For example, a request for a sign language
interpreter from an individual who is deaf directly relates to the individual's
substantial limitation in hearing. A request for a change in lunch schedule
from an individual who must take medication at a certain time to
manage a medical condition like diabetes is indirectly related to the
individual's impairment of the endocrine system.
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"Reassignment" means the assignment of an employee with a disability
who is no longer able to perform the essential functions of his/her regular
position to another vacant position assigned to the same pay grade as
the employee's regular position, the duties and responsibilities of which
the employee is able to perform with or without a reasonable
accommodation.
"Request for reasonable accommodation" means a statement by an
individual or the individual's representative requesting a reasonable
accommodation.6
"Substantially limits" 7 means that the individual is:
unable to perform a major life activity that the average person in
the general population can perform; or
• restricted as to the condition, manner, or duration under which she
or he can perform a particular major life activity as compared to
the condition, manner, or duration under which the average
person in the general population can perform the same major life
activity.
"Undue hardship" means, with respect to the provision of an
accommodation, a significant difficulty or expense incurred by the
County should it implement the request for accommodation. Consider
the following factors when analyzing "undue hardship":
• the nature and net cost of the accommodation;
• the overall financial resources of the facility or facilities involved;
the number of employees at the facility; the effect on expenses
and resources; and the number, type, and location of the facilities;
• the type of operations of the employer, including the composition,
structure, and functions of the workforce, the geographic
separateness, and administrative or fiscal relationship of the facility
or facilities in question to the employer; and
• the impact of the accommodation upon the operation of the
facility, including the impact on the ability of other employees to
perform their duties and the impact on the facility's ability to
conduct business.
RESPONSIBILITIES
Department/Agencies
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A. Appoint an Accommodation Resource Manager (ARM).$
B. Appoint decision makers who will be responsible for receiving
and processing requests for reasonable accommodation
during the job application process for all recruitments (open
competitive and internal), training sessions, and special events
hosted by the department/agency. Documentation shall be
noted on the appropriate form: DHR EO 011, Documentation
of Reasonable Accommodation for Job Application Process,9
or DHR EO 012, Documentation of Reasonable Accommoda-
tion for Training, Special Event, etc. Documentation of the
accommodation and any supporting documentation
required for the accommodation shall be secured in a
confidential file and stored with the recruitment and/or event
file.
C. Include a statement in all internal recruitment notices which
informs employees whom to call to request a reasonable
accommodation for the job application process. (Please see
Endnote No. 9.)
D. Include a statement in all letters that invite job applicants to
interview and/or participate in performance tests which
informs job applicants of the name of the decision maker and
the contact information for requesting a reasonable
accommodation. (Please see Endnote No. 9.)
E. Include a statement in all announcements of training classes
and special events which informs employees and others who
may attend the event whom to call to request a reasonable
accommodation, use of assistive technology, and/or an
auxiliary aid. (Please see Endnote No. 9.)
Ensure personnel who will act as ARMs and decision makers
become familiar with and follow these procedures.
G. Ensure ARMs and decision makers attend training on Title I of
the Americans with Disabilities Act, Reasonable
Accommodation, and the Interactive Process offered by the
Department of Human Resources.
H. Engage in the interactive process, as necessary, with job
applicants, employees, and participants in training classes or
special events who request an accommodation based upon
a medical condition.
Conduct departmental job searches and identify suitable
positions within their departments/agencies, engaging in the
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interactive process, as necessary, with employees who,
because of a disability, are unable to perform the essential
functions of their regular positions.
Refer employees with disabilities who cannot be reassigned to
vacant positions within their own departments/agencies
because they are unable to perform the essential functions of
any position with or without a reasonable accommodation to
the Department of Human Resources for priority placement.
K. Document the provision or the denial of reasonable
accommodation, as appropriate, using Form DHR EO 016,
Documentation of Reasonable Accommodation for
Employee; Form DHR EO 016A, Reasonable Accommodation
Work Sheet; and Form DHR EO 016B, Reasonable
Accommodation Checklist.
Ensure confidentiality by storing documentation of
accommodations and medical information in the
accommodation file. If the individual for whom the request is
being made is an employee, the accommodation file shall be
secured and filed alongside the employee's medical file. If
the individual for whom the request is being made is not an
employee, the accommodation file shall be secured and
stored with the recruitment file or with the event file,
whichever the case may be.
M. Ensure that the ARMs and/or decision makers designate other
decision makers who, in their absence, will process requests
for reasonable accommodations.
N. Budget for accommodations which are expected or
anticipated (e.g., a department/agency who has an
employee that is deaf should annually budget for assistive
technology and auxiliary aids and services, such as qualified
interpreters).
O. Deny accommodations only when any one or a combination
of the following factors is present:
There is insufficient medical documentation to determine
that the individual has a disability as defined in these
procedures or that the individual needs a reasonable
accommodation;
The requested accommodation would result in an undue
hardship as defined in these procedures;
The requested accommodation would require removal
of an essential job function;
The requested accommodation would lower a
performance or production standard; and
The requested accommodation would result in a direct
threat to the individual who requested the
accommodation or to others which cannot be
eliminated or reduced by a reasonable
accommodation.
II. Accommodation Resource Managers (ARMS)
A. Be a resource within the department/agency on
accommodation issues by providing information to employees
upon request.
B. Provide support to decision makers who process requests for
accommodation.
C. Assist decision makers with requests for accommodation that
must be expedited.
D. Process requests for medical information and/or functional
limitations, which decision makers deem necessary to process
accommodation requests.10 For all requests for medical
information, ask the individual to first sign Form DHR EO 014,
Authorization for Release of Medical Information, which shall
accompany a Confidential Request for Medical information
letter, Form DHR EO14A (employee) or Form DHR EO14B (job
applicant). (Tips for Requesting Medical Information are
provided in the enclosures to these procedures.)
File documentation of accommodation and medical
information in the accommodation file separate from the
employee's personnel file. During the job application process,
secure documentation of the accommodation and any
supporting documentation required for the accommodation
in a confidential file stored with the recruitment file.
F. Assist the decision maker in providing a temporary
accommodation when the accommodation can be
provided easily without a significant risk of substantial harm to
the employee or others, notwithstanding that the 15-day
period for providing an accommodation may be suspended
pending a request for medical information.
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G. Conduct department -wide job searches and engage in the
interactive process, as necessary, with employees who are
unable to perform the essential functions of their regular
positions.
H. Refer those employees who, after a department -wide job
search, are unable to perform the essential functions of any
suitable vacant position with or without a reasonable
accommodation to the Department of Human Resources for
priority placement.
III. Supervisors, Managers, and Other Employees Assigned to be
Decision Makers
A. Refrain from denying any employee's request for a change or
adjustment at work for a reason related to a medical
condition until they have determined that there is no
accommodation obligation.
B. Process requests for accommodation immediately.
C. Engage in the interactive process and communicate regularly
with the employee requesting accommodation until a
reasonable accommodation is found or all options are
exhausted.
D. Document all requests for accommodations, steps in the
interactive process, etc. Maintain documentation pertaining
to accommodation in a separate, confidential file, the
accommodation file.
E. Confirm requests for accommodation whenever possible with
the employee or job applicant after receiving an
accommodation request from a third party, and document
such confirmation.
F. Contact the ARM for assistance in requesting additional
medical information or when other information is needed to
process requests for accommodation.
G. Document the provision of a temporary accommodation as
such, using Form DHR EO 015, Documentation of Temporary
Accommodation. Ask the employee to sign Form DHR EO 015
and place the signed form in the accommodation file. Give a
copy to the employee.
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H. Refer to and complete Form DHR EO O1613, "Reasonable
Accommodation Checklist" in the enclosures of these
procedures when considering accommodation requests.
Immediately inform the ARM when, after engaging in the
interactive process, it is not possible to accommodate an
employee in his/her regular position; and refer the employee
to the ARM for a department -wide job search.
Refrain from discussing employees' medical conditions,
disabilities, and accommodation requests with other
employees; share information with other managers/supervisors
in the department/agency on a need -to -know basis only.
K. After implementing an accommodation, check with the
employee from time to time to gauge the effectiveness of the
accommodation; identify and resolve any problems, etc.
Note and document these checks and place in the
accommodation file.
IV. Employees
A. Review these procedures. Sign Form DHR EO 009,
Acknowledgment of Receipt of Procedures for Providing
Reasonable Accommodation for Individuals with Disabilities,
and return to their departmental designate.
B. Follow instructions provided on notices of internal recruitments
or in letters to attend interviews or participate in performance
or other tests to request accommodations. Complete and
submit Form DHR EO 010, Reasonable Accommodation
Request for Job Application Process.
C. Follow instructions provided on announcements of training
and other special events to request accommodations.
D. Cooperate and participate in the interactive process as
necessary to assist decision makers who are considering their
requests for reasonable accommodation.
E. Immediately inform a decision maker when they do not wish
to accept a specific offer of reasonable accommodation
and explain why they believe the proposed accommodation
would not be effective or desirable.
F. Cooperate in providing appropriate documentation to the
ARM when requested.
G. Immediately inform their supervisors when they are
experiencing difficulty with a reasonable accommodation
and/or a reasonable accommodation is not working.
H. Immediately inform their supervisors, if appropriate, or the ARM
if they experience harassment in the workplace because they
requested or received an accommodation.
Request an accommodation, if needed. Complete and
submit to decision maker (supervisor) Form DHR EO 013,
Employee Request for Reasonable Accommodation.
V. Department of Human Resources - Equal Opportunity Officer
A. Ensure all departments and agencies receive copies of these
procedures and have appointed ARMS.
B. Provide training on the Americans with Disabilities Act,
reasonable accommodation, the interactive process, and
these procedures.
C. Provide information and guidance to departments and
agencies, ARMS, decision makers, employees, and other
persons regarding these procedures, the Americans with
Disabilities Act, and the Americans with Disabilities
Amendments Act (ADAAA).
D. Review complaints alleging a violation of these procedures
and follow procedures outlined in the Anti -Discrimination and
Harassment Procedures.
PROCEDURES
1. Departments/agencies appoint an ARM.
2. Departments/agencies inform the Director of Human
Resources of the ARM's appointment.
3. Departments/agencies appoint decision makers to process
accommodation requests forjob application procedures
during Open Competitive Recruitments and Internal
Recruitments, as needed.
4. Departments/agencies appoint decision makers to process
accommodation requests for training sessions and special
events, as needed.
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NOTIFICATION
Departments/agencies distribute copies of these procedures
(Pages 1-20) and the enclosures for "Departmental and
Employee Use" (Forms DHR EO 009, DHR EO 010, and DHR EO
013); also notify employees of the departmental ARM.
2. Employees sign Form DHR EO 009, Acknowledgment of
Receipt of Procedures for Providing Reasonable
Accommodation for Individuals with Disabilities, and return it
to their departmental designate.
3. Departments/agencies file the signed Form DHR EO 009 in the
employee's personnel file.
REQUESTING ACCOMMODATIONS
JOB APPLICANTS - OPEN COMPETITIVE RECRUITMENTS
a) Follow instructions to request use of assistive technology,
an auxiliary aid, or other reasonable accommodation, if
needed, as provided on the Recruitment
Announcement.
b) Complete and submit Form DHR EO 010, Reasonable
Accommodation Request for Job Application Process, or
provide sufficient information to enable the decision
maker identified by the department/agency to
complete Form DHR EO 010.
c) Provide medical documentation relative to the request
for an accommodation, if requested to do so.
2. JOB APPLICANTS - INTERNAL RECRUITMENTS
a) Follow instructions to request use of assistive technology,
an auxiliary aid, or other reasonable accommodation as
provided on the Internal Recruitment Announcement.
b) Complete Form DHR EO 010, Reasonable
Accommodation Request for Job Application Process,
and submit it to the decision maker whose name is
provided on the Internal Recruitment Announcement or
provide sufficient information to enable the decision
maker to complete Form DHR EO 010.
c) Provide medical documentation to support the request
for an accommodation if requested to do so.
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3. EMPLOYEES
a) Follow instructions provided in announcements of training
sessions or other special events to request use of assistive
technology, an auxiliary aid, or other reasonable
accommodation, if needed.
b) To request an accommodation to perform job duties,
access or modify the workplace, etc., inform the decision
maker (supervisor) orally or by e-mail of the need for
accommodation or complete Form DHR EO 013,
Employee Request for Reasonable Accommodation,
and submit to the decision maker. Employees who are
unable to complete Form DHR EO 013 in writing shall
provide sufficient information to the decision maker who
will complete the form.
RECEIVING AND PROCESSING ACCOMMODATION REQUESTS -
DEPARTMENTS/AGENCIES
1. Upon receipt of an accommodation request from a Job
Applicant in an internal or open competitive recruitment, the
decision makers identified to receive such requests shall
complete Form DHR EO 011, Documentation of Reasonable
Accommodation for the Job Application Process; engage in
the interactive process, as necessary, then consider and
process the requests as soon as possible, if reasonable; and
inform job applicants of the status of their requests.
Documentation of the accommodation and any supporting
documentation required for the accommodation shall be
secured in the accommodation file and stored with the
recruitment file.
2. Upon receipt of requests for use of assistive technology, auxiliary
aids, or other reasonable accommodations, if needed for
training sessions or other special events, the decision makers
shall complete Form DHR EO 012, Documentation of
Reasonable Accommodation for Training, Special Event, etc.;
consider and process the requests as soon as possible, if
reasonable; and inform requestors of the status of their requests.
Documentation of the accommodation and any supporting
documentation required for the accommodation shall be
secured and stored with the event file.
3. Upon receipt of an accommodation request from an
employee, the decision maker shall engage in the interactive
process and keep the employee who requested the
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accommodation informed of the status of the request. If the
need for the accommodation is obvious and the
accommodation is readily achievable, it is not necessary to
follow this step-by-step procedure. The accommodation should
simply be provided.' 1
4. Except for extenuating circumstances, if an agreement is
reached on reasonable accommodation, the accommodation
shall be provided within 15 business days from the date the
request was received or sooner, if possible.
5. The decision maker, who needs additional information to
process an accommodation request, may ask the ARM to
conduct research, contact consultants at the Job
Accommodation Network, or to assist with expediting an
accommodation request.
6. When additional medical information is needed because the
need for accommodation is not obvious or has not already
been established, the decision maker shall inform the ARM. The
ARM shall ask the individual to complete and return Form DHR
EO 014, Authorization for Release of Medical Information.
7. Upon receipt of the completed Form DHR EO 014, Authorization
for Release of Medical Information, the ARM shall request
medical information from the individual's medical professional
by submitting a Confidential Request for Medical Information
Letter, Form DHR EO 14A (employee) or DHR EO 14B (job
applicant) to the individual's medical professional. The ARM
shall refer to the Guidelines Re: Writing a Request for Medical
Information Letter and Tips for Requesting Medical Information
provided in the enclosures to these procedures.
8. When additional medical information is needed to process an
accommodation request, the 15-day period is suspended. If
the ARM determines that medical information is not needed
because the individual's disability is obvious or has already
been established by a prior request for accommodation, the
15-day period will resume as soon as the ARM notifies the
decision maker of this. When the ARM receives medical
information that sufficiently supports the request for
accommodation, the 15-day period shall resume.
9. When assistive technology, the cost of which cannot be
covered in the department/agency's budget, is needed to
facilitate a reasonable accommodation, the decision maker
will notify the ARM.
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10. The ARM will notify the Department/Agency Head of the need
for assistive technology. In the event the department/agency
does not have monies available to fund the accommodation,
the department/agency must seek out other sources of funding
to pay for the accommodation.
11. When extenuating circumstances exist that will cause a delay in
deciding on a reasonable accommodation request, the
decision maker must notify the individual of the reason for the
delay and the approximate date on which provision of the
reasonable accommodation is expected.
12. If there is a delay in providing an approved accommodation,
the decision maker shall notify the ARM. In such a
circumstance, the decision maker shall determine if temporary
measures may be implemented to assist the individual who
requested the accommodation and consult with the ARM. For
example, if the purchase of assistive technology to assist an
individual with a visual impairment is delayed, the decision
maker may assign employees to read documents and other
materials to the individual with the visual impairment until the
assistive technology is received. The decision maker shall note
the provision of temporary accommodation on Form DHR EO
015, Documentation of Temporary Accommodation.
13. Form DHR EO 016A, Reasonable Accommodation Work Sheet is
completed by the decision maker to document the process
resulting in approval or denial of a request for reasonable
accommodation. The completed original form shall be placed
in the accommodation file with a copy to the Equal
Opportunity Officer/ADA Coordinator.
14. The decision maker shall communicate the outcome of the
reasonable accommodation request to the requestor
(individual and/or individual's representative) by filling out Form
DHR EO 016, Documentation of Reasonable Accommodation
for Employee. The completed original form is provided to the
requestor, a completed copy of the form shall be placed in the
accommodation file and a copy is provided to the employee if
she/he was not the requestor. The explanation for any denial
shall be written in plain language, clearly stating the specific
reasons for the denial, i.e., why the decision maker believes that
the accommodation would not enable the individual to
perform the essential duties of the position or why the
accommodation would result in an undue hardship or pose a
direct threat to the individual who requested the
accommodation or others.
Un
APPEAL
If the request for accommodation is denied, an individual
may file a complaint under the Anti -Discrimination and
Harassment Procedure within the involved department.
Individuals may also file a complaint with the Equal
Opportunity Officer under the Anti -Discrimination and
Harassment Procedure.
2. Individuals who are dissatisfied with the County's decision
regarding a reasonable accommodation may also file
complaints with the Hawai'i Civil Rights Commission and the
U.S. Equal Employment Opportunity Commission. Individuals
are responsible to contact those agencies for information
regarding their criteria for filing complaints.
ENCLOSURES- FOR -DEPARTMENTAL AND EMPLOYEE USE
1. DHR EO 009, Acknowledgment of Receipt of Procedures for
Providing Reasonable Accommodations for Individuals with
Disabilities
2. DHR EO 010, Reasonable Accommodation Request Form for
Job Application Process
3. DHR EO 013, Employee Request for Reasonable
Accommodation
ENCLOSURES - FOR DEPARTMENTAL USE
1. DHR EO 011, Documentation of Reasonable Accommodation
for Job Application Process
2. Sample Statements Sheet
3. DHR EO 012, Documentation of Reasonable Accommodation
for Training, Special Event, etc.
4. DHR EO 014, Authorization for Release of Medical Information
5. DHR EO 014A, Confidential Request for Medical Information -
Employee
6. DHR EO 014B, Confidential Request for Medical Information -
Job Applicant
7. Tips for Requesting Medical Information
8. DHR EO 015, Documentation of Temporary Accommodation
9. DHR EO 016, Documentation of Reasonable Accommodation
for Employee
10. DHR EO O16A, Reasonable Accommodation Work Sheet
11. DHR EO 016B, Reasonable Accommodation Checklist
HM.
Endnotes
Departments/Agencies may permit the ARM to also function as the decision
maker when appropriate.
2 When determining whether an individual's impairment rises to the level of
disability under the ADA, the determination should be made without considering
the benefits of any steps taken to mitigate or lessen the effects of the impairment,
except for ordinary eyeglasses and contact lenses.
3 Individuals meet the requirements for being "regarded as" having a disability if
they are discriminated against because of an actual or perceived impairment,
whether or not the impairment limits or is perceived to limit a major life activity.
An individual cannot be regarded as having an impairment if the impairment is
transitory and minor. A transitory impairment is an impairment with an actual or
expected duration of three months or less. Individuals only "regarded as"
disabled are not entitled to reasonable accommodations.
4 A job function may be considered essential for any number of reasons,
including, but not limited to, the following:
• the function may be essential because the reason the position exists is to
perform the function, e.g., a bus driver's position exists to operate the bus;
• the function may be essential because of the limited number of
employees available among whom the performance of the job function
can be distributed;
• the function may be so highly specialized that the incumbent in the
position is hired for his or her expertise or ability to perform the particular
function; and
• sometimes, an essential function is performed infrequently but the
consequence of not performing it would be severe. For example,
firefighters do not routinely carry people out of burning buildings, but the
consequence of a firefighter not being able to carry a person out of a
burning building would be severe in that it could result in that person's
death.
5 In many instances, the appropriate reasonable accommodation may be so
obvious to the employer and the qualified individual with a disability that it may
not be necessary to proceed by following this step-by-step procedure. For
example, if an employee who uses a wheelchair requests her desk to be placed
on blocks to elevate the top of the desk above the arms of the wheelchair and
the decision maker complies, an appropriate accommodation has been
requested, identified, and provided without the employee or employer engaging
in the step-by-step interactive process.
6 The request does not have to be in writing nor does it have to use legal
language. An employee who tells a supervisor that she/he is having difficulty
performing a job function because of a medical condition has made a request
for reasonable accommodation, and the supervisor must take the request for
W
accommodation seriously by considering it and engaging in the interactive
process.
7 The ADA Amendments Act states that the term "substantially" should not be
interpreted strictly. In addition, the question of whether a major life activity is
substantially limited "should not demand extensive analysis."
8 The ARM's responsibilities relate to employment. We, therefore, suggest
appointing the departmental human resources representative.
9 Forms and other documents mentioned in these procedures are provided as
Enclosures for Employee Use and Enclosures for Departmental Use, as applicable,
at the end of this document.
10 Requests for medical information are permissible only when a disability or the
need for a reasonable accommodation is not obvious. Requests for medical
information must be limited in scope to documentation that substantiates the
disability or functional limitations, their impact on the individual's ability to work,
and the need for accommodation. Whenever applicable, all requests for
medical information shall include a copy of the Position Description which
highlights the essential duties which the employee is expected to perform.
I If during a disciplinary procedure an employee discloses for the first time that a
disability is the reason for the misconduct or poor performance under scrutiny
and requests an accommodation, the supervisor may proceed to impose the
appropriate discipline for the misconduct or poor performance. However, the
supervisor has also now received notice that the employee may have a disability
and may be entitled to reasonable accommodation. The supervisor must
engage in the interactive process to determine if the employee has a disability
and is entitled to a reasonable accommodation with respect to any future
performance or conduct issues. For detailed guidance on this subject, please go
to the website of the U.S. Equal Employment Opportunity Commission at
www.eeoc.aov and see the publication, "The Americans with Disabilities Act:
Applying Performance and Conduct Standards to Employees with Disabilities."
20
DHR EO 009
(Re -issued: July 2018)
County of Hawaii
Acknowledgment of Receipt of Procedures for Providing
Reasonable Accommodation for Individuals with Disabilities
I certify that I have received a copy of the County of Hawaii Procedures
for Providing Reasonable Accommodation for Individuals with Disabilities.
Date:
Print Name:
Signature:
Position Title:
Department:
DHR EO O10
(Re -issued: July 2018)
CONFIDENTIAL
County of Hawaii
Reasonable Accommodation Request Form
for Job Application Process, up to and Including Interview
Please complete this form and submit it to the staff person identified to
receive accommodation requests for the job application process.
Name:
Address or other contact information:
Position applied for:
Department:
Accommodation requested for:
(Please check all that apply)
❑ Application process
❑ Testing/examination
❑ Interview
❑ Accessibility to facility
Type of accommodation requested:
Telephone No.
Accommodation needed for (specify date, time, and location):
Reasonable Accommodation Request Form - DHR EO O10 CONFIDENTIAL
Job Application Process
Page 2 of 2
Reason for the accommodation request
What limitations) is/are interfering with your ability to apply for a position?
Documentation provided:]
❑ Yes ❑ No
Signature
For County use only:
Received by:
Name
Date
Date
The requirement for documentation of applicant's limitation(s) is only permissible when
the need for accommodation is not obvious.
DHR EO 013
(Re -issued: July 2018)
CONFIDENTIAL
County of Hawaii
Employee Request for Reasonable Accommodation
Please complete this form and submit it to your supervisor to request a
reasonable accommodation to better access your workplace, perform
your job duties, or to enjoy a benefit of employment.
Name: Telephone No.:
Other contact information:
Job Title/Department/Location:
Accommodation Requested for:
(Please check all that apply and identify the specific element of your
employment for which you are requesting the accommodation)
❑ Access to workplace: What feature of your workplace is giving you
difficulty?
❑ Performance of job duties: What job duty (or duties) is giving you
difficulty?
❑ Benefit of employment: What benefit of employment is giving you
difficulty?
F Other (please specify)
Request for Reasonable Accommodation - DHR EO 013
Employee
Page 2 of 3
Type of Accommodation Requested:
Is your request time sensitive? ❑ Yes
CONFIDENTIAL
❑ No
If yes, please explain and provide date accommodation is needed.
Do you have any suggestions for options we can explore?
❑ Yes ❑ No
If yes, please explain:
Reason for the Accommodation Request
Why are you requesting this accommodation?
Signature Date
Request for Reasonable Accommodation - DHR EO 013 CONFIDENTIAL
Employee
Page 3 of 3
FOR COUNTY USE ONLY:
Received by:
Name Date
DHR EO 011
(Re -issued: July 2018)
WeIZ119110"'Lli I
Documentation of Reasonable Accommodation
for Job Application Process
Name of Requestor:
Position applied for:
Department:
Type(s) of Accommodation Requested:
Request for Accommodation Granted:
Name of Decision Maker
Note Specifics:
Date:
Signature of Decision Maker
If the request for accommodation was denied, please check all that
apply below:
❑ Accommodation Ineffective
❑ Accommodation Would Cause Undue Hardship
❑ Medical Documentation Not Provided
❑ Medical Documentation Inadequate
❑ Other (Please identify)
Documentation - Reasonable Accommodation - DHR EO 011 CONFIDENTIAL
Job Application Process
Page 2 of 2
Detailed reason(s) for the denial of reasonable accommodation (be
specific, e.g., explain why the accommodation is ineffective and/or
causes undue hardship, what production standard is reduced or lowered,
what essential job function the accommodation would eliminate, etc.).
If the individual rejected an offer of a reasonable accommodation, give
the reason(s) why the individual rejected the offered accommodation.
State why you believe the rejected accommodation would be effective.
Name of Decision Maker Signature of Decision Maker
Date Accommodation Denied
(Re -issued: July 2018)
Sample Statements Sheet
Sample statements for inclusion in:
Job Application Process (Open Competitive Recruitments/ Internal
Recruitments►
Individuals with disabilities who wish to request use of an auxiliary aid or
other type of reasonable accommodation during the job application
process, please telephone (name) at (telephone number)
to make your request. You may be asked to provide medical
documentation to support your request.
Announcements of Training or Special Events
Individuals with disabilities who wish to request use of an auxiliary aid or
other type of reasonable accommodation to access this program may do
so by contacting (name) . at (telephone number) at the
time of registration or at least 5 days prior to the date of the class or the
event to make their request.
DHR EO 012
(Re -issued: July 2018)
CONFIDENTIAL
Documentation of Reasonable Accommodation for
Trainina, Special Event, etc.
Name of Requestor:
Accommodation Requested for:
Date Needed:
Department:
Type(s) of Accommodation Requested:
Request for Accommodation Granted: Date:
Name of Decision Maker Signature of Decision Maker
Note Specifics:
Request for Accommodation Denied because (check all that apply):
❑ Accommodation Would Cause Undue Hardship
❑ Other (Please identify)
Documentation of Reasonable Accommodation - DHR EO 012 CONFIDENTIAL
Training, Special Event, etc.
Page 2 of 2
Detailed reason(s) for the denial of reasonable accommodation (be
specific, e.g., explain why the accommodation is ineffective and/or
causes undue hardship, what production standard is reduced or lowered,
what essential job function the accommodation would eliminate, etc.).
If the individual rejected an offer of a reasonable accommodation, give
the reason(s) why the individual rejected the offered accommodation.
State why you believe the rejected accommodation would be effective.
Name of Decision Maker Signature of Decision Maker
Date Accommodation Denied
DHR EO 014
(Re -issued: July 2018)
County of Hawaii
(Department/Agency)
AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION
I hereby request and authorize
(Medical Professional's Name)
(Medical Professional's Address)
(Medical Professional's Telephone No.)
to release and send to
Name, Job Title
Department
Address
Telephone
E-mail
the following information about me:
Note to Physician: I understand this information is to help determine the extent of
and severity of my impairment(s), and the effect of the impairment(s) on the
activities noted below:
o Access to facilities
o Performance of job duties,
o Adjustment(s) to the workplace,
o and/or modifications) to enable me to perform my job duties.
Important Note:
The Genetic Information Non -Discrimination Act of 2008 (GINA) prohibits
employers and other entities covered by GINA Title II from requesting or
requiring genetic information of an individual or family member of the
individual, except as specifically allowed by GINA. To comply with GINA,
we are asking that you do not provide any genetic information when
responding to this request for medical information. 'Genetic information'
includes an individual's family medical history, the results of an individual's
or family member's genetic tests, the fact that an individual or family
member sought or received genetic services, and genetic information of a
fetus carried by an individual or an individual's family member or an
embryo lawfully held by an individual or family member receiving assistive
reproductive services.
I have read the above and fully understand its contents in their entirety; I am
satisfied with the reason and purpose for which my permission is given.
My consent is valid for 180 days or shall terminate on
whichever comes first, and may be revoked by me at any time except for action
already taken.
Employee's Name (print)
Date
Employee's Signature Telephone No.
DHR EO 14A
(July 2018)
County of Hawaii
Department of
Confidential Request for Medical Information - Employee
(Date)
Medical Professional Name
Street Address
City, State, Zip Code
Dear
Medical Professional Name:
Re: Request for Accommodation
Employee Name
I recently received information that the individual named above has a medical
condition which may impact her/his ability to perform essential job functions.
I am requesting additional information to assist me in determining whether this
employee needs an accommodation to perform essential job functions.
Please complete this form and return to me by . If you have any
(date)
questions about this inquiry, please contact me. My telephone number is
Enclosed please find a signed copy of an Authorization to Release Medical
Information and job description with essential functions highlighted.
Sincerely,
(Name)
(Title)
Confidential Request for Medical Information - Employee - DHR EO 14A
Page 2 of 4
Under the Americans with Disabilities Act, an individual has a disability if the
individual has an impairment that substantially limits one or more major life
activities.
Does
(name)
o Yes
have a physical or mental impairment?
What is the impairment?
o No
Is the impairment long-term or permanent? c) Yes o No
If it is not permanent, how long will the impairment last?
Is the impairment chronic or episodic?
(Please circle the word that applies).
Does the impairment limit a major life activity? o Yes o No
Please review the list of major life activities on the next page and check all that
are limited:
Major Life Activities
oCaring for oneself
oSitting
oWalking
olnteracting
oReaching
oConcentrating
oPerforming Manual
oThinking
oReading
oTasks
oSleeping
oReproduction
oLearning
oEating
oSpeaking
oHearing
oWorking
oSeeing
oLifting
oStanding
oOther:
oBreathing
(specify)
Please indicate if the impairment substantially limits any of the following bodily
systems:
olmmune oDigestive oBladder
oHemic oBowel oEndocrine
oNeurological o Normal Cell Growth
oMusculoskeletal
Does the impairment substantially limit one or more major life activities?
o Yes 0 No
Confidential Request for Medical Information - Employee - DHR EO 14A
Page 3 of 4
If the impairment is episodic in nature, does it substantially limit a major life
activity or bodily function when it occurs? o Yes o No
Reasonable accommodations are modifications or adjustments to the work
environment or to the manner or circumstances under which the position held is
customarily performed that enable an individual with a disability to perform the
essential functions of the position. Under the Americans with Disabilities Act, an
employee with a disability is entitled to an accommodation only when the
accommodation is needed because of a disability and the accommodation
does not create an undue hardship.
The employee is currently working in the position of
The essential job functions of this position are: (List all essential job functions).
The employee is having trouble performing the following essential job functions
because of the limitation(s) the employee is experiencing:
How does the employee's limitation interfere with his/her ability to perform the
job function(s)?
Do you have any suggestions regarding possible accommodations to improve
job performance? If yes, what are they?
How would your suggestions improve the employee's job performance?
Confidential Request for Medical Information - Employee - DHR EO 14A
Page 4 of 4
[GrOT1,7112, =-I a
Medical Professional's Signature Date
DHR EO 014B
(July 2018)
County of Hawai'i
Department of
Confidential Re ...................... . ..... . -- . ....... .. .................. quest for Medical Information - Job Applicant
(Date)
Medical Professional Name
Street Address
City, State, Zip Code
Dear
Medical Professional Name:
Re:
Job Applicant
quest for Accommodation
I recently received information that the individual named above has a medical
condition which may impact her/his ability to
o apply for a position with the County of Hawaii.
I am requesting additional information to assist me in determining whether this
individual needs an accommodation to better access our job application
process.
Please complete this form and return to me by -. If you have any
(date)
questions about this inquiry, please contact me. My telephone number is
Enclosed please find a signed copy of an Authorization to Release Medical
Information and a brief description of our job application process.
Sincerely,
(Name)
(Title)
Confidential Request for Medical Information - Job Applicant - DHR EO Ol 4B
Page 2 of 4
Under the Americans with Disabilities Act, an individual has a disability if the
individual has an impairment that substantially limits one or more major life
activities.
Does
(name)
o Yes
have a physical or mental impairment?
What is the impairment?
o No
Is the impairment long-term or permanent? o Yes
If it is not permanent, how long will the impairment last?
Is the impairment chronic or episodic?
(Please circle the word that applies).
Does the impairment limit a major life activity? o Yes o No
If the impairment is episodic in nature, does it substantially limit a major life
activity or bodily function when it occurs? o Yes o No
Please review the list of major life activities on the next page and check all that
are limited:
Major Life Activities
oCaring for oneself
oSitting
oWalking
olnteracting
oReaching
oConcentrating
oPerforming Manual
oThinking
oReading
oTasks
oSleeping
oReproduction
oLearning
oEating
oSpeaking
oHearing
oWorking
oSeeing
oLifting
oStanding
oBreathing
Please indicate if the impairment substantially limits any of the following bodily
systems:
olmmune oDigestive oBladder
oHemic oBowel oEndocrine
oNeurological
oMusculoskeletal
Confidential Request for Medical Information - Job Applicant - DHR EO Ol 4B
Page 3 of 4
Under the Americans with Disabilities Act, an individual with a disability is entitled
to an accommodation in the job application process only when the
accommodation is needed because of a disability.
is applying for the position of
(Name of the individual)
The application process involves (check all that apply)
o completing an application
o taking a test to determine knowledge
o taking a skills test
o participating in a job interview.
What limitation(s) would interfere with any of the activities noted above?
Reasonable accommodations are modifications or adjustments to the job
application process that would enable an individual with a disability to apply for
the position.
If the individual has a disability and needs an accommodation to apply for a job
because of the disability, the employer must provide a reasonable
accommodation, unless the accommodation poses an undue hardship.
Do you have any suggestions regarding possible accommodations to assist
—..................................... .........._..._.........._ in the job application process?
(name of individual)
If yes, what are they?
How would your suggestions assist
(name)
in applying for a job?
Confidential Request for Medical Information - Job Applicant - DHR EO 01 4B
Page 4 of 4
Comments:
Medical Professional's Signature Date
(Re -issued: July 2018)
TIPS FOR REQUESTING MEDICAL INFORMATION
✓ Seeking medical information is an option, not a requirement. In
some cases, you may be able to provide an adjustment (see
bulleted point below) for an employee without making any medical
inquiries. You may decide that a request is an undue hardship, if it
requires removal of an essential job duty, violation of a collective
bargaining agreement or lowering a production standard, without
needing to access an individual's medical information.
✓ If your department/agency routinely makes adjustments for
employees, e.g., granting flex time to those who request it, do not
consider a request for such an adjustment as a reasonable
accommodation under ADA or seek medical information when you
get such a request.
✓ Only ask for proof of disability if the disability is not obvious.
✓ If the individual's disability status has already been established by a
previous request for accommodation, there is no need to seek
more proof of disability.
✓ Only ask questions about the employee's ability to do the job, not
the individual's whole medical history.
✓ Only ask questions about the medical condition the individual
disclosed or gave you permission to inquire about, even if you
suspect the individual may have another condition.
✓ The U.S. Equal Employment Opportunity Commission's Final Rule on
the Genetic Information Non -Discrimination Act recommends
employers include the following language in all requests for medica
information:
The Genetic Information Non -Discrimination Act of 2008
(GINA) prohibits employers and other entities covered by
GINA Title II from requesting or requiring genetic
information of an individual or family member of the
individual, except as specifically allowed by GINA. To
comply with GINA, we are asking that you do not provide
any genetic information when responding to this request
for medical information. 'Genetic Information' includes an
individual's family medical history, the results of an
Tips for Requesting Medical Information
individual's or family member's genetic tests, the fact that an
individual or family member sought or received genetic services,
and genetic information of a fetus carried by an individual or an
individual's family member or an embryo lawfully held by an
individual or family member receiving assistive reproductive
services.
This language creates a safe harbor for employers and must be included
in all requests for employee medical information.
✓ Don't ask questions about prognosis because the individual's medical
condition or situation may change.
✓ Your letter to the Medical Professional should be a maximum of two
pages.
✓ If the medical professional does not provide the information you
requested, do not punish the individual who made the request. Consider
other available sources such as a physical therapist or rehabilitation
counselor to get information about the employee's functional abilities.
✓ It's the employer's responsibility to decide what is reasonable
accommodation, undue hardship, etc., not the medical professional's.
This information is derived from a presentation entitled "Medical Documentation
for Reasonable Accommodation Requests" by the Disability and Communication
Access Board, State of Hawai'i, Department of Health, Honolulu, Hawai'i.
DHR EO 015
(Re -issued: July 2018)
CONFIDENTIAL
County of Hawaii
Department of Human Resources
Documentation of Temporary Accommodation
To: From:
(Employee) (Supervisor)
Department/Agency
On you requested a reasonable accommodation:
(date)
. ... ,.__.w.... requested)._��.....����.........�. ......... ...........
(name the accommodation
We are in the process of considering your request for reasonable
accommodation on a permanent basis. In the interim, while we consider your
request, we will provide you with the following temporary accommodation:
until
(date)
Please be advised that this accommodation is being made on a temporary basis
until we have thoroughly considered your request, and no promise or guarantee
that this accommodation will be provided on a regular or permanent basis is
being made to you.
Please sign below to indicate that you understand this accommodation is being
provided on a temporary basis.
I understand this accommodation is being provided on a temporary basis only
until a decision about my request for accommodation is made and
communicated to me.
Employee Date
DHR EO O16
(Re -issued: July 2018)
CONFIDENTIAL
Documentation of Reasonable Accommodation for Employee
Name of Requestor:
Position:
Department:
Type(s) of Accommodation Requested:
Request for Accommodation Granted:
Name of Decision Maker Date
Note Specifics:
Request for Accommodation Denied Because (check all that apply):
❑ Accommodation Ineffective
❑ Accommodation Would Cost Undue Hardship
❑ Medical Documentation Inadequate
❑ Accommodation Would Require Removal of an Essential Function
❑ Accommodation Would Require Lowering of Performance or Production
Standard
❑ Other (please identify)
Detailed reason(s) for the denial of accommodation (be specific, e.g., explain
why the accommodation is ineffective and/or causes undue hardship, what
production standard is reduced or lowered, what essential job function the
accommodation would eliminate, etc.).
Documentation - Reasonable Accommodation - DHR EO Ol 6 CONFIDENTIAL
Employee
Page 2 of 2
If the individual rejected an offer of a reasonable accommodation, give the reasons)
why the individual rejected the offered accommodation.
State why you believe the rejected accommodation would be effective.
Request for Accommodation Denied:
Name of Decision Maker
Copy: Accommodation File
Employee:
Date
(Name of employee)
DHR Form EO 016A
Reasonable Accommodation Work Sheet
Date of Review:
Review By:
Date of Accommodations) Request:
Accommodations) Requested for (Name):
Work Schedule:
Supervisor/Manager:
Position:
Department:
Work Location:
(July 2018)
CONFIDENTIAL
1. Does the individual requesting the accommodations) have a physical or mental
impairment that substantially limits a major life activity?
If yes, answer #2 below.
2. What mental or physical limitations is the individual experiencing either described by
the healthcare provider or the individual? (Attach additional pages if needed.)
3. List the essential duties of the position, and attach position description with essential
duties highlighted:
Reasonable Accommodation Work Sheet - Confidential - DHR EO 016A
Page 2 of 5
4. What accommodations) has the employee or the employee's representative
requested?
5. Would the requested accommodations) enable the individual to perform the
essential duties of the job? Please explain.
Reasonable Accommodation Work Sheet - Confidential - DHR EO Ol 6A
Page 3 of 5
6. What forms of accommodations) were considered?
7. Would the considered accommodations) enable the individual to perform the
essential duties of the position? Please explain.
8. List the dates and times accommodations) were discussed with the individual who
requested them. Also note when additional information, if any, was requested and
when it was received.
Reasonable Accommodation Work Sheet - Confidential - DHR EO 016A
Page 4 of 5
9. Can the considered accommodations) be implemented without undue hardship?
if no, please complete # 11.
Was the accommodations) accepted?
10. If yes, when will the accommodations) be implemented?
11. If the considered accommodations) would create an undue hardship, document
all aspects of undue hardship below:
Reasonable Accommodation Work Sheet - Confidential - DHR EO 01 6A
Page 5 of 5
12. If the considered accommodation (s) would create an undue hardship, this must
be confirmed by Department Head.
I confirm that, as noted in #11, the requested accommodation (s) would create an
undue hardship to the department.
Department Head Signature:
Date:
13. If the considered accommodation (s) would create an undue hardship, is there
another accommodation (s) available? If yes, please
explain.
Comments:
14. Follow-up
Date:
Equal Opportunity Officer/ADA Coordinator
DHR Form EO 16B
(July 2018)
CONFIDENTIAL
Reasonable Accommodation Checklist
To Be Used by Decision Maker
Check all that apply
1. The Reasonable Accommodation procedure was initiated by
o job applicant request;
o employee request;
o employee or job applicant representative request;
o employee's medical professional;
o employee's supervisor;
0 other: (specify)
2. The job applicant or employee has
o an impairment that substantially limits a major life activity,
o an impairment that does not substantially limit a major life activity.
If the job applicant or employee does not have an impairment that
substantially limits a major life activity, whether chronically or episodically,
there is no duty to provide a reasonable accommodation and the rest of this
checklist need not be completed.
JOB APPLICATION PROCESS
3. If the Reasonable Accommodation Request pertained to the Job
Application Process, the job applicant requested an accommodation for
(check all that apply and continue to #4 and #5)
o the job application process;
o examination;
o performance test;
o interview;
0 other:
(specify)
4. The individual (or representative) who made the request completed and
submitted DHR Form EO 010 Reasonable Accommodation Request Form
for Job Application Process to the decision maker:
Yes No
Reasonable Accommodation Checklist
Page 2 of 5
5. If the job applicant requested an accommodation, the need for which
was not obvious, the decision maker requested medical supporting
information.
Yes No
6. The job applicant provided medical documentation and/or additional
medical information was obtained by medical professional.
Yes No
7. The decision maker engaged in the interactive process by speaking with
the job applicant to discuss the accommodation needed.
Yes No
8. If yes, the decision maker engaged in the interactive process by speaking
with the job applicant to discuss the accommodation needed to
o apply for a position,
o take an examination
o participate in an interview
o other
(specify)
9. The decision maker completed DHR Form EO 011 Documentation of
Reasonable Accommodation for Job Application Process.
Yes No
EMPLOYMENT
10.If procedure was initiated by supervisor, the reason for this is
o the need for accommodation was obvious;
o based upon objective evidence, the supervisor believed that the
employee was unable to perform essential job functions because of
a disability, and/or;
o the employee posed a direct threat because of a medical
condition.
Reasonable Accommodation Checklist
Page 3 of 5
1 1.The major life activities that are substantially limited are
N
N
12.There was no need to request additional medical information because
o the need for accommodation was obvious;
o the need for accommodation was established by a previous
accommodation request;
o sufficient medical information was provided by the employee or the
employee's medical professional.
13.If additional medical information was required,
o the ARM was notified,
o the ARM processed the request for additional medical information.
14.If additional medical information was required, the ARM used DHR Form
EO 014 Employee Authorization for Release of Medical Information.
Yes No
15.If additional medical information was required, the ARM referred to Form
DHR EO 14A or 14B, Confidential Request for Medical Information and TIPS
FOR REQUESTING MEDICAL INFORMATION:
Yes No
16.If additional medical information was required, the fifteen day period for
considering the reasonable accommodation request was suspended until
sufficient medical information was received.
Yes No
17.If the individual who requested an accommodation was an employee,
the decision maker engaged in the interactive process by
o meeting/speaking with the employee to identify the essential
functions of the employee's position,
o determining the precise job -related limitations imposed by the
disability,
o identifying potential accommodations,
o assessing the effectiveness of each potential accommodation in
enabling the individual to perform essential functions of the position,
o considering the preference of the individual with a disability,
o selecting and implementing the most appropriate accommodation
for the employee and the employer.
Reasonable Accommodation Checklist
Page 4 of 5
18.The individual who requested the accommodation did not engage in the
interactive process by not:
o cooperating with requests for medical information
o discussing his/her limitations and their impact on the performance
of essential job functions.
19.The individual who requested the accommodation engaged in the
interactive process by
o discussing his/her limitations and their impact on the performance
of essential job functions,
o cooperating with requests for medical information, if needed,
o suggesting alternate ways of performing job duties,
o suggesting purchase of assistive equipment,
o informing the decision maker what accommodations would work,
o informing the decision maker what accommodations would not
work.
20.If the provision of reasonable accommodation required the purchase of
equipment or service the cost of which had not been budgeted,
o the decision maker notified the ARM,
o the ARM notified the Department Head.
21. The equipment/service was purchased.
Yes No
22. If the answer is no, please explain why:
23. If the decision maker was not able to accommodate the employee in
his/her regular position:
o the ARM was notified;
o the ARM conducted a job search within the department.
24.If the employee who requested an accommodation was referred to the
Department of Human Resources for priority placement,
o there were no vacant positions within the department the
essential functions of which the employee could perform with or
without a reasonable accommodation;
o the employee posed a direct threat which could not be
eliminated by a reasonable accommodation.
Reasonable Accommodation Checklist
Page 5 of 5
25.The decision maker completed, provided a copy to EEO/ADA Coordinate
and filed Form DHR EO 016A, Reasonable Accommodation Work Sheet in
the Accommodation file.
26.The decision maker noted approval or denial of the accommodation on
DHR Form EO O16 Documentation of Reasonable Accommodation for
Employee:
a. Yes No
27.This information is retained in the Accommodation file:
a. Yes No