SAMPLE REQUEST FOR ACCOMMODATION
Communication Access and Other Modifications for
Workers Who Are Blind or Visually Impaired (1) Name of Human
Resources director,
supervisor, program
MEMORANDUM director, or another manager
TO: (1) ____________________________ (2) Your name
FROM: (2) ____________________________ (3) Today’s date
RE: Request for Reasonable Accommodation
DATE: (3) ________________________
(4) Optional: State the
name or a description of
This is a request for reasonable accommodation under the your condition using
Americans with Disabilities Act (ADA) and the California Fair language you feel
Employment and Housing Act (FEHA). If you are not the comfortable with.
appropriate person to receive this request, please notify me (5) Explain what form of
immediately, and forward this letter on to the person who handles accommodation you are
requests for reasonable accommodation. requesting, such as:
“documents in a format
I am a person with a “disability” under the ADA and the FEHA. accessible with text-to-
[My condition is (4) _________________.] Due to my disability, I speech software.”
need (5) _______________________________________________. Accommodations for blind
and visually impaired
According to the ADA and the federal Equal Employment individuals include:
Opportunity Commission (EEOC), communication access is a form documents in alternative
of reasonable accommodation. See 42 U.S.C. § 12111(9)(B), formats such as Braille,
EEOC Enforcement Guidance on Reasonable Accommodation and enlarged print, or digital
files;
Undue Hardship Under the Americans with Disabilities Act (Oct.
17, 2002), and EEOC Factsheet, Questions and Answers About written minutes or notes
summarizing meetings;
Blindness and Vision Impairments in the Workplace and the
Americans with Disabilities Act (Jan. 11, 2011), all available at text-to-speech software
www.eeoc.gov. The EEOC has also recognized that modifications such as JAWS;
related to mobility (such as the use of canes and guide dogs) and computer equipment
transportation may be reasonable accommodations for blind and such as CCTV or a
visually impaired workers. See Questions and Answers About computer screen
magnifier for enlarging
Blindness and Vision Impairments in the Workplace. documents and visual
materials;
Please let me know if you require reasonable medical
schedule changes to
documentation of my condition, or if you wish to propose permit travel by public
alternative accommodations to those I have requested. I am transportation or in some
available and eager to engage in the interactive process with you. cases a driver;
The use of a cane or
Thank you. service animal at work;
another accommodation.