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Sample Language for Accommodation Request Letters

Examples of Accommodation Request Letters

From the desk of Jose Gonzalez Lopez, MPH, Employment Specialist


The first step in requesting an accommodation in the workplace is to decide how to make the request. I often suggest employees consider making a written request so they can decide what to say and how to say it without the stress of a face-to-face meeting with their employer. However, writing such an initial request can feel intimidating and employees can get nervous about what to include in the letter and how to word it. At JAN, I often discuss options with employees about what might be useful to include and how to clearly explain what accommodation is needed.

As a starting point, JAN offers general guidance about writing an accommodation request letter, which lays out possible elements to include in the body of the letter. But for employees who need more ideas, the following examples offer additional guidance about how to communicate the need for an accommodation for various types of medical conditions. As you consider these examples, you may find it helpful to review How to Disclose a Disability and Request Accommodations in the Workplace on JAN’s page for Individuals, which also provides more information about the Americans with Disabilities Act (ADA). For accommodation ideas by disability or limitation, visit JAN’s A to Z page.

Sample Accommodation Request Letter: Back Condition

Date of Letter
Your name
Your address
Employer's name
Employer's address

Dear [Insert employer’s name here]:

I am writing this letter to submit a request for accommodations in the workplace. I have pain in my lower back. Sitting or standing for long periods of time in the same position is causing increased pain and is decreasing my mobility. I would like to request for accommodations to help decrease the pain caused by my back condition. Below I have included some possible ideas that could help at my workstation. If there are any other ideas or options that you could provide it would be greatly appreciated.

  • Sit-stand desk
  • Ergonomic chair
  • Modified break schedule
  • Telework

Please let me know if you need additional information or would like to discuss additional ideas. Would you please let me know in the next week? Thank you for considering my request.

Sincerely,
Your signature
Your printed name

CC: to appropriate individuals

Sample Accommodation Request Letter: Allergies

Date of Letter
Your name
Your address
Employer's name
Employer's address

Dear [Insert employer’s name here]:

Given ongoing construction in our building and increased dust from it, my allergy symptoms have greatly increased. It has become more difficult to breathe while in the office, even in my own personal office. I have experienced an increase in fatigue, as well as eye irritation. I would like to suggest the following accommodations to address this issue:

  • Personal air purifier (for my office) and air filters (for HVAC), or
  • Telework

Please let me know if you need additional information or would like to discuss additional ideas. Would you please let me know in the next week? T hank you for considering my request.

Sincerely,
Your signature
Your printed name

CC: to appropriate individuals

Sample Accommodation Request Letter: Mental Health

Date of Letter
Your name
Your address
Employer's name
Employer's address

Dear [Insert employer’s name here]:

I have been having medical issues that have affected my mood, sleep schedule, concentration, and focus. I would like to request accommodations so that I might be able to perform my job effectively before my performance starts to suffer.

Workplace distractions interfere with my concentration and focus so I would like to try noise cancelling headphones to minimize sound distractions. In addition, having a list of what I might need to do for the workday/week could also help me keep track of my work.

Please let me know if you need additional information or would like to discuss additional ideas. Would you please let me know in the next week? Thank you for considering my request.

Sincerely,
Your signature
Your printed name

CC: to appropriate individuals

 

Letter