Orange County NC Website
Browse       Search
DocuSign Envelope ID:6E9B5308-6677-4F2E-9268-29D6E1A4FD76 <br /> NFL TILL <br /> r <br /> REASONABLE ACCOMMODATION <br /> AND INTERACTIVE PROCESS DOCUMENTATION FORM' E <br /> G <br /> 1. Name of individual requesting reasonable accommodation: <br /> I=. <br /> f <br /> 2. Dates of communications with individual regarding types of reasonable <br /> accommodation. Please list types of communication (email, letter,meeting) <br /> and other individuals present,if any. <br /> 3. Type(s) of reasonable accommodation requested: <br /> 4. If individual and company were able to agree on a reasonable accommodation, <br /> please identify the reasonable accommodations agreed to: <br /> f <br /> 5. If request for reasonable accommodation denied, please identify the reason <br /> (may check more than one box).2 <br /> • Accommodation ineffective . <br /> • Accommodation would cause undue hardship <br /> • Medical documentation inadequate <br /> • Accommodation would require removal of an essential function <br /> • Accommodation would require lowering of performance or production <br /> standard <br /> ❑ Other(please identify): <br /> f <br /> I <br /> G <br /> 6. Detailed reason(s) for the denial of reasonable accommodation (must be <br /> specific, e.g. why accommodation is ineffective or causes undue hardship): <br /> r <br /> 'NOTE TO EMPLOYER: The purpose of this form is to provider documentation that the employer engaged in the <br /> interactive process. <br /> ''The decision to deny reasonable accommodation is fraught with peril. We strongly recommend that an employer �.. <br /> consult with legal counsel before determining that it cannot reasonably accommodate an employee's disability. We <br /> also strongly recommend that legal counsel review this form(and particularly questions 5 and 6)before it is <br /> finalized if an employer decides to deny reasonable accommodation. i. <br /> is <br />