Accommodation

As a caregiver, you may encounter a situation where you need specific accommodations to perform your job effectively. If you do not already have an open accommodation request, this guide will walk you through the process of creating one using the request intake form. This step-by-step approach helps you clearly and accurately communicate your needs for a smooth review process.

Step-by-Step Guide to Requesting an Accommodation

Step 1: Understanding the purpose of the intake form and download the form

The accommodation request intake form serves to gather essential information about your accommodation. Use the steps below to help you complete the intake form.

download here

Note: After clicking the Download Here button, download a copy of the Excel form to fill out. Save the form once you have completed it.

Step 2: Providing basic request information

• Identifying information: Please provide your first name, last name, and employee ID number.

• Accommodation request: Start by stating the nature of your request. This is the overall reason why you need the accommodation.

• Start date: Indicate the date when you would like your requested accommodation to begin. This helps prioritize and schedule the necessary arrangements.

• End date: Specify the date when you anticipate the need for the accommodation to end, if applicable. If the end date is unknown or indefinite, make a note of this.

Step 3: Supplying treating provider information

Your treating provider can offer valuable insights into your condition and the accommodations that might benefit you. Please provide the following details:

• Name:The full name of your treating provider.

• Address: The complete address where your provider is located.

• Phone number: A contact number for your treating provider to help with details, if necessary.

Step 4: Identifying challenges due to disability

Identify which tasks are challenging for you because of your disability. Here are some examples you can choose from:

• Breathing

• Learning

• Reading

• Sitting

• Standing

• Walking

• Talking

• Concentrating

• Hearing

• Manual Tasks

• Communicating with others

• Other (specify any additional difficulties not listed)

Step 5: Describing job limitations

In your own words, describe how your disability impacts your ability to perform your job duties as a caregiver. Be as specific as possible.

Step 6: Specifying accommodation needs

Clearly state which accommodations you are requesting. Options might include:

• Equipment

• Accessible materials

• Changes to the workplace

• Job restructuring

• Leave as an accommodation

• Work at home

• Modified work schedule

• Reassignment

• Other (specify any additional accommodations not listed)

Step 7: Documentation

If you have information from your provider, please provide it to the with your intake form via the email address below when you submit your request.

Step 8: Additional information

If there is any other information that could support your request or help your Accommodations Specialist understand your situation better, please include it in this section. This might include previous accommodations that were helpful or specific concerns you have.

Finalizing your request

Once you have completed the accommodations request intake form, review it carefully to ensure all information is accurate and complete.

Step 9: Emailing your request

Email your completed request to Provaccommodations@providence.org. Once submitted, it will be assigned to an Accommodations Specialist.

Keep a copy for your records.

---

Why this matters?

The Americans with Disabilities Act (ADA), the Pregnant Workers Fairness Act (PWFA), and other federal and state laws require employers to provide reasonable accommodations for qualified individuals protected by these laws.

The ADA is a federal law that prohibits employment-related discrimination against employees and job applicants with a disability. Under the ADA, employers must provide reasonable accommodations to a caregiver who cannot perform the essential functions of their job due to a “disability”, unless the accommodation causes undue hardship. Disability is defined under the ADA as: a physical or mental impairment that substantially limits one or more major life activities; a person who has a history or record of such an impairment; or a person who is perceived by others as having such an impairment.

The PWFA is a federal law that requires employers to provide a reasonable accommodation for job applicants and caregivers with “known limitations” related to or arising out of pregnancy, childbirth or related medical conditions, unless the accommodation causes undue hardship. The PWFA specifically requires that employers provide reasonable accommodations for workers who are temporarily unable to perform the essential functions of their role due to pregnancy and/or childbirth-related reasons. In addition, many states have their own laws requiring that employers provide workplace accommodations for pregnant workers.