Reasonable Adjustment Request (UK) (Acas)
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]
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