Reasonable Adjustment Request by Acas
This template assists an employee in formally requesting a reasonable adjustment from their employer to help manage their health at work. It guides the employee on how to detail the impact of their health, propose suitable adjustments, and suggest ways to mitigate any potential effects on the organization. The document aims to facilitate a constructive dialogue between the employee and employer regarding workplace accommodations.
Reasonable Adjustment Request (Template)
A template for an employee to use if they want to request a reasonable adjustment.
Instructions or options to fill in this template are in [square brackets].
[Today's date]
Dear [name of manager / employer / HR manager],
I'm writing to make a reasonable adjustment request to help me manage my health at work.
[Give details of how your health affects work. Or how your work affects your health. You do not need to share your disability, but it can help your employer understand your needs. For example:
I've been diagnosed with anxiety
I'm receiving treatment for my mental health condition
I have arthritis in my knees which makes it difficult to use public transport to get to the workplace
I'm receiving cancer treatment]
My current working pattern and role is [give details].
To help me manage my work and health I ask that [give details of what adjustments you would find helpful and why. For example, starting and finishing an hour later to miss rush hour and reduce anxiety when travelling to work].
This would mean that I can [give details of any benefits to the employer. For example, feeling calmer when I start and end work, so I can focus better].
To deal with any effects the change could have on my work or the organisation, I suggest [give details of how you and your employer could deal with any effects. For example, someone in the team will pick up client calls before I start work, and I’ll respond when I get in].
Please could we meet to talk about my reasonable adjustment request.
I look forward to your reply.
Yours sincerely,
[Your name]
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