Workplace accommodations request template
A respectful template to request workplace accommodations (US wording).
Who this is for
Workplace support looking for practical, educational support.
How to use
- Adapt the language to your workplace policy.
- Keep requests specific and practical.
Request outline
I am requesting adjustments/accommodations to support my work. These are intended to improve focus, reduce overload, and help me meet role expectations.
- □ Quiet workspace or noise‑reducing options
- □ Written instructions after meetings
- □ Flexible start time for regulated routines
- □ Meeting agenda shared in advance
Impact summary
| Adjustment | Impact on work | How success will be measured |
|---|---|---|
| Quiet space | Less sensory overload | Fewer interruptions |
| Written summaries | Clearer task follow‑through | Reduced rework |
Related resources
Trust & evidence
Educational resource — not medical advice.
Citations
Sources are copy‑only for transparency — external links are not clickable.
World Health Organization: Mental health and wellbeing
https://www.who.int/teams/mental-health-and-substance-use
UNICEF: Supporting mental health and wellbeing
https://www.unicef.org/mental-health
Job Accommodation Network (JAN)
https://askjan.org/
Last reviewed
16 Jan 2026
Next review due
15 Jul 2026
Updated
16 Jan 2026
Evidence & sources
4 sources · tiers A, B
Update history
- 16 Jan 2026contentInitial printable published and reviewed.
Educational information only — not medical advice. Read the disclaimer.