Workplace Accommodation Request and Plan Form

• Part A: the employee's request, with the reason, the barrier at work and ideas for accommodation
• Part B: a functional abilities section for a health care provider, with no diagnosis requested
• Part C: options considered, outside expert and representative tick boxes, and the decision with reasons and evidence
• Part D: the accommodation plan, review frequency, format needs, access and storage, signatures and a review log
• The Ontario version follows the individual accommodation plan elements of the accessibility regulation for employers with 50 or more employees
• Legal notes on the duty to accommodate and on privacy
• Fillable Word document and a print-ready PDF for each version (5 pages each)

Select your province, territory or federal jurisdiction before purchasing. Each version follows that jurisdiction’s human rights law. The federal version is for federally regulated employers and follows the Canadian Human Rights Act. Not available for Quebec.

Small and growing Canadian businesses, and the owners, managers and HR professionals who receive accommodation requests and need a fair, documented process.