Faculty and Staff Request for Reasonable Workplace Accommodation Form

In the context of assessing an accommodation request, medical documentation may be needed. Medical documentation is often needed to determine if the employee has a disability covered by the ADA and is entitled to an accommodation (i.e., has a permanent disability, as distinguished from temporary disability, that substantially limits one or more major life activities, affects the employee’s ability to perform essential job functions, and is of sufficient severity) and if so, to help identify an effective accommodation.

Generally, in the context of an accommodation, medical inquiries related to an employee’s disability and functional limitations are permissible and may include consultations with knowledgeable professional sources, such as doctors, occupational and physical therapists, rehabilitation specialists, and organizations with expertise in adaptations for specific disabilities. The Office of Institutional Equity is the University unit charged with collecting medical documentation for the purpose of determining reasonable accommodations. In the event that medical documentation is required, the employee will be provided with the appropriate forms to submit to their medical provider. The employee has the responsibility to ensure that the medical provider follows through on requests for medical information.


I give the Johns Hopkins University Office of Institutional Equity permission to explore coverage and reasonable accommodations under the Americans with Disabilities Act of 1990, as amended (ADA). I understand that all information obtained during this process will be maintained and used in accordance with ADA and all legal and regulatory requirements as they pertain to medical and genetic information confidentiality. In situations where OIE requires input on questions related to medical or psychological documentation submitted to support a request for reasonable accommodation, I authorize OIE to consult with Johns Hopkins University Director of Occupational Health (or designee) and/ or the medical/mental health professional, concerning the provided documentation.