Provider Resource: Filling Out an Accommodation Request Form for Workplace Job Coaching

Filling Out an Accommodation Request Form for Workplace Job Coaching 

Did you know that nearly 20% of people in the workforce identify as having a disability (U.S. Bureau of Labor Statistics, 2025)? Despite this, many individuals remain unaware of their rights to request accommodations at work (for more information on how to request workplace accommodations, check out our blog: I’m Neurodivergent, How Do I Request Workplace Accommodations?) . One of the most beneficial accommodations is job coaching, which can help enhance performance and productivity. In this blog post, we will guide you through the process of filling out an accommodation request form for workplace job coaching, ensuring that you possess the necessary knowledge to advocate for yourself effectively. From understanding the importance of accommodations to the specifics of the request form, we will cover everything you need to know to embark on this crucial journey. 

Understanding Workplace Accommodations 

Workplace accommodations are necessary adjustments made in the work environment to empower employees with disabilities. This concept not only promotes inclusivity but also enhances the productivity of employees. For individuals who face challenges in their work performance due to various disabilities, accessing a qualified job coach can serve as a beneficial resource. 

The Importance of Job Coaching 

Job coaching provides employees with personalized support to effectively navigate their roles in the workplace. A job coach assists in skill development, time management, and even social interactions, thereby addressing specific areas that may hinder performance. The role of a job coach is to guide employees in their career journey, ultimately leading to a more fulfilling work experience.  

It’s crucial to understand your legal rights as an employee. Under the Americans with Disabilities Act (ADA), employers are required to provide reasonable accommodations to employees who disclose their disabilities. Recognizing these rights not only empowers employees but also encourages a culture of acceptance and support within the workplace. 

The Accommodation Request Form 

The accommodation request form is the first step in this process. This form allows employees to formally request assistance and delineate how their work may be impacted without necessary accommodations. 

Steps to Filling Out the Accommodation Request Form 

To ensure you effectively fill out the accommodation request form, follow these steps: 

• Gather Necessary Information: Before you begin filling out the form, collect relevant information such as your job title, a brief description of your medical condition, and how it affects your job performance. This evidence establishes your eligibility for accommodations.  

  Providers who can complete this form for you:  

  • The following licensed professionals are eligible to complete accommodation forms: 

  • Psychiatrists and other Physicians 

  • Nurse Practitioners 

  • Physician Assistants 

  • Psychologists 

  • Clinical Social Workers 

  • Mental Health Counselors and Therapists 

  • Other licensed healthcare or mental health professionals familiar with the employees’ needs 

•  Detail Your Needs: Clearly articulate the specific accommodations you are requesting. When it comes to job coaching, describe the areas where you believe support is needed, such as time management, task prioritization, or interpersonal skills. 

• Document the Impact: Explain how the absence of these accommodations has negatively affected your job performance Providing concrete examples can help substantiate your request.  

• Consult with Your HR or Accommodations Team: Once you’ve completed the form, it may be beneficial to consult with your human resources department. They can provide guidance as well as ensure that your request is processed promptly. 

• Submit the Form: After reviewing the form for accuracy, submit it according to your company’s protocol. It may require submission to your HR department or a designated supervisor.  

Example Provider Responses for the Accommodation Form 

Question 1: Does your patient have an impairment that substantially impacts his/her ability to perform any one or more of the essential functions of his/her job? 

• Example Response: ☑ Yes 

If “yes” to Question #1, please identify the impairment(s) at issue: 

• Example Response: The individual experiences challenges related to executive functioning, including but not limited to the areas listed in question 2. 

 
Question 2: If “yes” to Question #1, please list the specific function(s) you believe your patient is unable to perform: 

• Example Response: The patient may have challenges with: 

  • Attention

  • Productivity

  • Long term habits

  • Memory

  • Building consistent habits

Question 3: Please list the limitation(s) and/or restrictions (if any) that you believe result in a need for accommodation and explain why you believe the restrictions or accommodations are medically necessary for the employee to perform his/her essential job functions: 

• Example Response: The individual may experience challenges managing executive functioning demands without structured support. Workplace job coaching for the areas above is an appropriate accommodation because it equips the employee with tools to perform their essential job functions effectively and sustainably. 

Question 4: Please describe any suggested accommodations that will enable your patient to perform all of the required essential job functions. If remote work is recommended, please complete page 3 of this form. 

• Example Response: Workplace Job Coaching 

What Happens After Your Request is Approved? 

If your request is approved, it’s crucial to utilize the resources available to you effectively: 

• Engage with Your Job Coach: Make sure to establish a regular meeting schedule and outline clear goals with your job coach. 

• Communicate Openly: Keep the lines of communication open with your coach throughout the process. This creates a productive working dynamic. 

• Assess Progress: Set benchmarks to evaluate your progress regularly. Continuous feedback will enhance your learning experience. 

For more details on the specific workplace coaching process, please see the graphic below:

The How Skills Coaching Process

Conclusion: Taking the Next Step Towards Success 

Knowing how to navigate the accommodation request process for workplace job coaching can significantly change your career trajectory. By requesting the appropriate support, you demonstrate self-advocacy as well as a commitment to your professional development. Advocating for yourself is paramount. Remember, every employee deserves the opportunity to succeed, and asking for assistance is the first step. 

By mastering the accommodation request process, you become empowered and equipped to handle workplace challenges while seeking the support you deserve. The journey to finding the right career path can be daunting, but with the right tools at your disposal, it is an achievable goal. Embrace this process and take charge of your work life! 

References: 

U.S. Bureau of Labor Statistics. (2025, February 25). Persons with a disability: Labor force characteristics — 2024. https://www.bls.gov/news.release/disabl.nr0.htm