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Documenting Job Functions_Medical Limitations

April 1, 2000
Related Topics: Disabilities, Featured Article
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This form is used to note what the employee employee restrictions are and what the job essential/marginal functions are.

CONFIDENTIAL INFORMATION, ACCESS LIMITED TO:


JOB FUNCTIONS / LIMITATIONS REVIEW

"If an otherwise qualified individual with a disability cannot perform one or more essential job functions, because of a disability, the employer must include in the assessment of qualification, whether reasonable accommodation would enable the person to perform those functions." EEOC TAM 2.3(C)

Applicant / Employee Name:


Functional Limitations: (Physical and/or Mental)




Essential Functions Requiring Accommodations: (Please refer to the attached job description)




If the need for accommodation is not obvious, or the employer questions the need, documentation of functional limitations may be requested. EEOC TAM 3.6

Documentation Not Requested: ______

Documentation of Need on File: ______

Documentation Requested:
     Date Required: ____________
     Date Received: ____________

Marginal Tasks to be Reassigned:




Marginal Replacement Tasks:




OTHER LIMITATIONS TO BE ACCOMMODATED:

"Reasonable accommodations must be provided to enable an employee with a disability to enjoy benefits and privileges of employment equal to those enjoyed by similarly situated non-disabled employees." EEOC TAM 3.3

Other accommodations to be considered for equal accessibility ? (restrooms, lunch rooms, conference rooms, exercise facilities, etc.) Yes _____ No _____ If yes, please list.

1. _________________________________
2. _________________________________
3. _________________________________
4. _________________________________

Completed By:
     Signature _________________________________
     Title ____________________________________

The information and forms contained in this feature are intended to provide useful information on the topic covered, but should not be construed as legal advice or a legal opinion.

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