Reasonable Adjustment Request (UK) (Acas)
Updated 9 October 2025
This template helps an employee formally request a reasonable adjustment from their employer. It guides the employee in explaining how their health affects their work and proposing specific adjustments, along with potential benefits and solutions for any impact on the organization. The template encourages a meeting to discuss the request further.
Template Reasonable Adjustment Request
A template for an employee to use if they want to request a reasonable adjustment.
[date]
Dear [recipient name],
I'm writing to make a reasonable adjustment request to help me manage my health at work.
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
To help me manage my work and health I ask that
This would mean that I can
To deal with any effects the change could have on my work or the organisation, I suggest
Please could we meet to talk about my reasonable adjustment request.
I look forward to your reply.
Yours sincerely,
[employee name]
About this template
What is this template?
Reasonable Adjustment Request (UK) (Acas) is a free, ready-to-use Employment Contracts template you can open, customize, and download on GitLaw. It gives you a professionally structured starting point, so you never have to draft from a blank page. The wording is plain and modern, organized into clear sections that are easy to read, edit, and adapt to your own situation before you share or sign it.
When should you use it?
Reach for this Employment Contracts template whenever you need a reliable agreement quickly and want to be sure the essentials are covered. It suits individuals, freelancers, startups, and established businesses alike. Instead of paying for a document drafted from scratch, you can start here, tailor the details to your arrangement, and have a polished draft ready in minutes. Always review the final wording against the laws that apply where you live or do business.
What's typically included?
A well-drafted Employment Contracts usually sets out the parties involved, the scope of the agreement, and each side's rights and responsibilities. Expect sections covering key terms and definitions, how long the agreement lasts, how it can be ended, and what happens if something goes wrong. This template brings those building blocks together in a sensible order, so you can focus on the specifics rather than worrying about what to include. Open it to read the full document, then sign up to edit, negotiate, and e-sign it directly in GitLaw.