A reasonable adjustment is often a small change that makes a big difference, and it is simpler to get right when it is written down. This form lets the employee describe the issue and the adjustment they are asking for.

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This form template is supplied in fully editable MS Word format and can be easily customised and edited. The document uses pre-defined style formatting throughout, with all text in Calibri font for improved readability.
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• Form number and title
• Information-classification
• Version
• Page number / total pages

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Further Reading

Further guidance on reasonable adjustments and inclusion:

• Equality, Diversity and Inclusion
• Managing Staff Absence
• Mental Health and Wellbeing at Work

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This file is included in the alphaZ subscription. This form is also included in the ISO 9001 Toolkit, and in every alphaZ ISO toolkit that covers managing people, so the toolkit route gives you this file plus everything else you need in one download.

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Reasonable Adjustment Request Form Template

A reasonable adjustment request form for an employee to ask for a change to their working conditions and for the request to be assessed. It records the issue or situation, the adjustments requested, and space for the assessment and any action taken.

Making reasonable adjustments is a duty under the Equality Act 2010, and a clear form helps you consider each request fairly and keep a record of the outcome. 

Built for Fair, Documented Adjustments

The form captures what you need to consider and record a request:

• The employee, their role and line manager
• An overview of the issue or situation behind the request
• The specific adjustments the employee is asking for
• An assessment section - who assessed it, the decision and any action taken

What's Included in this Reasonable Adjustment Request Form

The form is set out so a request can be raised and assessed in one place:

• Employee details - name, date, job title and line manager
• The request - overview of the issue and the adjustments requested
• For office use - assessed by, date, whether the request is accepted, and comments or actions taken

Who Needs a Reasonable Adjustment Request Form?

Any employer may receive a request for a reasonable adjustment, whether for a disability, a health condition or a temporary need. A consistent form helps you handle each one fairly and on record. It suits any small or growing business and supports people-management records.