How to Fill Out and Submit a Kaiser Reasonable Accommodation Form

To request a workplace accommodation at Kaiser Permanente, complete the internal accommodation request form through the HR system and submit it to your supervisor, Human Resources, or the Integrated Disability Management (IDM) team, along with a physician certification describing your functional limitations. The Kaiser reasonable accommodation form is Kaiser’s internal paperwork for documenting a request under the Americans with Disabilities Act, and while filling it out is the cleanest way to move things forward, the law does not actually require a specific form to start the process — a verbal request or email to your manager is legally sufficient to put Kaiser on notice.¹

That said, a written form creates the record you want if anything later goes wrong. Here is how to prepare it, what to attach, and where to send it.

Work Out the Details Before You Write

The single biggest reason accommodation requests stall is vague wording. Before you open the form, get two things clear in your own mind: the functional limitation you are dealing with, and the specific change you want at work.

A functional limitation describes what you cannot do, or cannot do safely, in your current role. “I cannot stand for longer than twenty minutes at a time” is a functional limitation. “I have a back condition” is a diagnosis, which the form does not need and your supervisor is not entitled to know.

The requested accommodation should be equally concrete. “A sit-stand desk at my current workstation” is more useful than “ergonomic equipment.” “A start time of 10 a.m. instead of 8 a.m. to manage medication side effects” is more useful than “schedule flexibility.” If the condition is temporary, note the expected duration. Common accommodations Kaiser employees request include ergonomic chairs, height-adjustable desks, larger monitors, additional breaks, shift changes, part-time schedules during a flare-up, unpaid leave, assistive equipment for clinical staff, and temporary reassignment to less physically demanding duties.²

If you are unsure what to ask for, the Job Accommodation Network (askjan.org) maintains a free, searchable database of accommodations organized by disability and job type, and its consultants can help you brainstorm before you fill anything in.

What the Form Asks For

Kaiser’s internal accommodation request form is a short document that captures:

Your employee identification details and current position.
A description of the functional limitation — again, what you cannot do, not your diagnosis.
The specific accommodation you are requesting.
The expected duration, if the need is temporary.
Whether you are attaching medical documentation.

You do not need to prove on the form itself that you have a disability under the ADA. That is what the physician certification is for. Keep the form focused on the workplace barrier and the change that would fix it.

The Physician Certification

When your disability and the need for accommodation are not obvious, Kaiser can ask for medical documentation, but the law limits what the organization can demand. Documentation must establish two things: that you have an ADA-qualifying disability, and that the disability creates a functional limitation requiring the accommodation you requested. Kaiser cannot request your complete medical records or information unrelated to the specific limitation at issue.¹

If you receive care within Kaiser Permanente, the Release of Information (ROI) department can help your doctor complete a Physician Certification for Reasonable Accommodation Considerations. Before you contact ROI, talk with your doctor about your activity restrictions so they can document a work-and-activity-restriction form. Once your doctor has done that, contact the ROI department in your region and request the certification.³

A strong physician statement focuses on what you cannot do. “Patient cannot lift more than ten pounds or stand for longer than twenty minutes at a time” tells Kaiser exactly what needs to change. A letter that just says “patient has a disability and needs accommodation” will likely be returned as insufficient, and Kaiser is entitled to ask for more. If the documentation is found lacking, Kaiser has to tell you what is missing and give you a reasonable opportunity to supplement it.¹

If your provider’s documentation still leaves questions about your functional limitations, Kaiser can send you to a health professional of its choice for an independent examination, but that exam must be limited to the disability and limitations at issue.

Where to Submit the Form

You can direct the completed form and attachments to any of the following:

Your direct supervisor or manager. They do not need to know your diagnosis, only the functional limitation and what you need.
Human Resources. HR can walk you through the internal paperwork and route you to the right team.
The Integrated Disability Management team. Kaiser’s IDM team handles accommodation and return-to-work cases and can coordinate between your department and your healthcare provider.

Email is generally the best channel because it timestamps the submission. Keep a copy of everything you send. Start a personal file with the form, the physician certification, and any messages exchanged about the request. Note the dates of verbal conversations and who was present. This record matters if the process later stalls or the request is denied.

What Happens After You Submit

Once the form is in, Kaiser is required to engage in what the EEOC calls an interactive process, which is an informal back-and-forth dialogue aimed at finding an effective accommodation. Kaiser cannot simply approve or deny the request in silence; failure to participate in this conversation can itself violate the ADA.¹

The depth of the exchange depends on the request. Sometimes the disability and the fix are both clear and there is little to discuss. Other times, Kaiser will ask about your specific limitations, explore alternatives, or propose a trial period. You do not have to identify the perfect solution yourself, but you should describe the workplace barrier as clearly as you can.

Kaiser can offer an alternative to what you asked for if your first choice is too costly or disruptive, but the alternative has to actually work. If you ask for a private office to manage anxiety, Kaiser might instead offer noise-canceling headphones and a relocated workstation in a quieter area. The organization gets the final word on which effective option to provide, but it cannot pick one that does not address the limitation.

There is no statutory deadline for a response, but the EEOC has warned that unnecessary delays in the interactive process can themselves violate the ADA. If weeks pass without a response, follow up in writing and keep copies.

Confidentiality

All medical information gathered during your request must be kept confidential and stored separately from your general personnel file. Supervisors are told only what changes to implement, not what condition prompted them. The ADA limits disclosure to managers who need to know about restrictions, first-aid personnel if the condition might require emergency treatment, and government officials investigating ADA compliance.⁴

If Your Current Job Cannot Be Modified

When no modification can make your current role workable, reassignment to a vacant position is the accommodation of last resort. Kaiser must first exhaust accommodations that keep you in your existing job. If none work, the organization should look for a vacant position at an equivalent level of pay and status for which you are qualified. If no equivalent role exists, a lower-level vacancy is the next option.¹ The IDM team coordinates this search and can connect employees with openings through a transitional task bank.

If the Request Is Denied

Kaiser can deny an accommodation if it would create an undue hardship, meaning a significant difficulty or expense relative to the organization’s resources and operations.¹ For an organization the size of Kaiser Permanente, that bar is high, because the EEOC considers the resources of the entire entity rather than one clinic or department. A denial can also rest on a finding that the accommodation would create a direct threat to workplace safety that cannot be reduced through other means. Either way, the denial should include the specific reasons and, ideally, a proposal for an alternative that would work.

The interactive process does not end with the first “no.” You can request reconsideration with additional documentation or a revised proposal. If you believe the denial was unjustified, you also have the right to file a charge of discrimination with the EEOC, and California employees can file with the California Civil Rights Department under the Fair Employment and Housing Act. Filing deadlines run from the date of the denial regardless of any ongoing internal grievance, so track them separately from your conversations with Kaiser.⁵

Religious and Pregnancy-Related Requests

If your request is based on a sincerely held religious belief rather than a disability — a scheduling conflict with a day of worship, for example — the legal basis is Title VII of the Civil Rights Act, and Kaiser must accommodate you unless doing so imposes more than a minimal burden on the business.⁶ Pregnancy-related limitations are covered separately under the Pregnant Workers Fairness Act, which does not require you to meet the ADA’s disability standard; any physical or mental condition related to pregnancy, childbirth, or a related medical condition qualifies, even if temporary.⁷ The submission channels through your supervisor, HR, or IDM are the same, but the medical documentation and interactive-process questions look different, so tell whoever receives your request which framework applies.

1
U.S. Equal Employment Opportunity Commission. Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the ADA
2
U.S. Equal Employment Opportunity Commission. Employer-Provided Leave and the Americans with Disabilities Act
3
Kaiser Permanente. Request Records, Forms, and Certifications
4
U.S. Equal Employment Opportunity Commission. Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees
5
U.S. Equal Employment Opportunity Commission. Time Limits For Filing A Charge
6
U.S. Equal Employment Opportunity Commission. Religious Discrimination
7
U.S. Equal Employment Opportunity Commission. 42 USC 2000gg – Pregnant Workers Fairness Act