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Employee Request for Disability-Related Reasonable Accommodation

The College at Brockport is dedicated to providing effective, reasonable accommodation for individuals with

disabilities. To identify and implement such accommodation, the College engages in an “interactive process,” in

which the College and individuals with disabilities who request accommodations work together to reach an

appropriate outcome. The Affirmative Action Officer is responsible for working with qualified individuals with

disabilities to arrange changes in the work environment or procedures which enable an individual with

disabilities to experience equal employment opportunities.

Process

1. Employee completes the Employee Request for Disability-Related Reasonable Accommodation Form

and submits to the Affirmative Action Officer.

2. Employee provides their doctor with the Health Care Provider Information for Reasonable

Accommodation Request Form and instructs the doctor to submit completed form to the Affirmative

Action Officer.

3. Affirmative Action Officer:

• Receives and reviews the employee request form and health care provider form.

• Will notify the employee if a review of the request and of supporting documentation is

inconclusive, or if it is determined that medical documentation is inadequate or otherwise

problematic. The Affirmative Action Officer will specify to the employee why the

documentation is unacceptable, and the employee will be asked to submit additional

supporting documentation.

• Contacts the employee’s manager and/or other Human Resources representatives as

necessary.

4. If, based on the review, the Affirmative Action Officer determines that the employee is entitled to an

accommodation and that the proposed accommodation is reasonable as defined by the Americans with

Disabilities Act (ADA), the Affirmative Action Officer will consult with the employee’s supervisor about

appropriate methods of implementing the requested accommodation or some variation thereof.

5. The Affirmative Action Officer will provide the employee and their manager written notification of the

approval or denial of the request for disability-related accommodation.

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APPEAL PROCESS

If the employee does not agree with the decision of the Affirmative Action Officer due to either:

a. Being denied the accommodation of; or,

b. Disagreement on the recommended accommodation(s) and an agreement cannot be

reached, the employee may initiate a formal appeal. The appropriate steps are:

• An appeal must be submitted in writing to the Assistant Vice President for Human

Resources, The College at Brockport, 409 Allen Administrative Building, 350 New

Campus Drive, Brockport, NY 14420. The appeal must set forth the specific action

disputed and the specific accommodation sought by the employee. The Assistant

Vice President for Human Resources will notify the Affirmative Action Officer and

obtain a copy of the employees file, including the documentation of the disability

and the need for accommodation(s), if any, recommended by the evaluator and the

Affirmative Action Officer.

• The Assistant Vice President for Human Resources will convene a meeting with the

employee and the Affirmative Action Officer within 2 weeks of receiving the written

appeal. The Assistant Vice President for Human Resources will make a decision on

the appeal after meeting with the employee and reviewing the file and

documentation.

• The Assistant Vice President for Human Resources has the authority to make the

final determination regarding accommodation.

Disability Accommodation Resources

Questions or concerns regarding policy or services should be directed to:

Tammy Gouger

Affirmative Action Officer

409 Allen Administration Building

350 New Campus Drive

Brockport, NY 14420

585-395-2442

tgouger@brockport.edu

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Definitions

The following definitions are based on the New York Human Rights Law. Unlike both the Americans

with Disabilities Act (ADA) and the Rehabilitation Act of 1973, the New York Human Rights Law

protects all individuals with physical, mental or medical impairments that either impede normal bodily

function or are demonstrable by medically accepted diagnostic technique. The protection of the

federal statutes is limited to those impairments that substantially limit one or more major life

activities.

Essential Job Functions: Essential functions are those fundamental to the position; A function is

essential if not performing that function would fundamentally change the job occupation for which

the position exists.

Person With A Disability: a person who has “a physical, mental, or medical impairment,” who, upon

provision of a reasonable accommodation if needed, is able to perform in a reasonable manner, the

activities involved in the job or occupation sought or held. Individuals with a disability also include

persons who have a record or history of impairment, even if they do not currently have impairment.

These individuals are protected from bias, but only current impairments need to be reasonably

accommodated. Persons who have a condition regarded by others as an impairment, or who are

incorrectly perceived as having an impairment, are also protected from discrimination. However, only

actual impairments need to be reasonably accommodated. Physical, Mental or Medical Impairment:

any impairment “resulting from anatomical, physiological, genetic, or neurological conditions which

prevents the exercise of a normal bodily function or is demonstrable by medically accepted clinical or

laboratory diagnostic techniques.”

Qualified Person with a Disability: a person with a disability who, as defined below, can reasonably

perform the activities involved in the job, and who satisfies the requisite skill, experience, education

and other job-related requirements of the position which the individual holds or desires.

Reasonable Accommodation: The New York Human Rights Law, the Rehabilitation Act of 1973, and

the Americans with Disabilities Act (ADA) of 1990 require that employers provide reasonable

accommodation to the known physical or mental limitations of otherwise qualified applicants or

employees with disabilities, unless it can be demonstrated that providing such accommodations would

result in undue financial or operational hardships.

Reasonable accommodation refers to the modifications or adjustments to a job application process

which enables a qualified individual with a disability to be considered for the position sought and to

modifications or adjustments to the work environment or the manner in which a job is performed. An

accommodation is reasonable if it removes or mitigates the barriers to performance caused by the

individual’s impairment, and does not cause undue hardship to the employer.

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Reasonable Performance: The Human Rights Law protects from discrimination those who can

reasonably perform the job, with reasonable accommodation, if needed, despite the person’s

impairment. Reasonable performance is not perfect performance or performance unaffected by the

disability, but reasonable job performance reasonably meeting the employer’s needs to achieve its

business goals. Ability to reasonably perform the “activities involved in the job or occupation” means

the ability, with or without accommodation, to satisfactorily perform the essential functions of the job

as established by the employer. The employer’s judgment, as to what is minimally acceptable

performance will prevail, so long as standards for performance are applied equally to all employees in

the same position.

Undue Hardship: this means significant difficulty or expense to the employer. In determining whether

an accommodation would result in undue hardship, any relevant factor may be considered.

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____

_________________________________________________ ___________________________

EMPLOYEE REQUEST FORM FOR DISABILITY-RELATED REASONABLE ACCOMMODATION

Instructions: To request accommodation in the workplace due to a disability, please submit the completed

request form to the Affirmative Action Officer. In addition, the Health Care Provider Information for

Reasonable Accommodation Request Form must be completed by a qualified healthcare professional who has

made the diagnosis of your condition and/or is currently providing treatment of the condition.

Name________________________________________Email___________________________________

Budget Title___________________________________Campus Title_____________________________

Division______________________________________Work Location_____________________________

Manager’s name_______________________________________________________________________

Work Phone __________________________________Home Phone _____________________________

Describe how your disability affects your ability to perform the essential job functions of your position:

I am requesting the following accommodation(s):

Describe how this requested accommodation(s) is necessary to perform the essential job functions of your

position:

mployee Signature Date

I understand that all information provided to the Affirmative Action Officer is kept confidential and will only

be shared with individuals directly involved in the review of the accommodation(s) request.

Return completed form to: The College at Brockport, Tammy Gouger, Affirmative Action Officer, 409

Allen Administration Building, 350 New Campus Drive, Brockport, NY 14420.

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HEALTH CARE PROVIDER INFORMATION FOR REASONABLE ACCOMMODATION REQUEST FORM

Employee Name: ____________

Questions to help determine whether an employee has a disability.

For reasonable accommodation under the Americans Disability Act (ADA), an employee has a

disability if they have an impairment that substantially limits one or more major life activities or

a record of such impairment. The following questions may help determine whether an

employee has a disability:

1. Does the employee have a physical or mental impairment? Yes No

a. If yes, what is the impairment? (Please be specific)

b. Is the impairment(s) temporary? Yes No

c. If the above is yes, what is the anticipated duration?

Answer the following question based on what limitations the employee has when their

condition is in an active state and what limitations the employee would have if no mitigating

measures were used.

Mitigating measures include things such as medication, medical supplies, equipment, hearing

aids, mobility devices, the use of assistive technology, reasonable accommodations or auxiliary

aids or services, prosthetics, learned behavioral or adaptive neurological modifications,

psychotherapy, behavioral therapy, and physical therapy. Mitigating measures do not include

ordinary eyeglasses or contact lenses.

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1. Does the impairment substantially limit a major life activity? Yes____No

Note: The impairment does not need to significantly or severely restrict the individual to

meet this standard. It may be useful in appropriate cases to consider the condition under

which the individual performs the major life activity; the manner in which the individual

performs the major life activity; and/or the duration of time it takes the individual to

perform the major life activity, or for which the individual can perform the major life

activity.

a. If yes, what major life activity(s) is/are affected?

Bending

Hearing

Reaching

Breathing

Interacting WithOthers

Reading

Caring for Self

Learning

Seeing

Concentrating

Lifting

Sitting

Eating

Performing Manual Tasks

Sleeping

Speaking

Standing

Thinking

Walking

Working

Other

b. If yes, what major bodily functions is/are affected?

Bladder

Bowel

Brain

Cardiovascular

Circulatory

Digestive

Endocrine

Genitourinary

Hemic

Immune

Lymphatic

Musculoskeletal

Neurological

Normal Cell Growth

Operation of an Organ

Reproductive

Respiratory

Special Sense Organs &Skin

Other: (describe)

Questions to help determine whether an accommodation is needed. An employee with

a disability is entitled to an accommodation only when the accommodation is needed

because of the disability. Accommodation ideas and suggestions are always welcome

and can be helpful however, employers do get to choose the effective

accommodation that will be provided for an employee, as outlined by the Equal

Employment Opportunity Commission (EEOC.) To assist us in determining the most

appropriate and effective accommodations, the employer needs to know what

specific symptoms and functional limitations are creating barriers for the employee.

The following questions may help determine whether the requested accommodation

is needed because of the disability. Please answer the following with as much detail as

possible.

1. What limitation(s) is interfering with job performance or accessing a benefit of

employment? (What is getting in the way of the employee from doing their job?)

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2. What specific job function(s) or benefits of employment is the employee having

trouble performing or accessing because of the limitations?

3. How does the employee’s limitation(s) interfere with their ability to perform

the job function(s) or access benefit of employment?

Questions to help determine effective accommodation options: If an employee

has a disability and needs an accommodation because of the disability, the

employer must provide a reasonable accommodation, unless the accommodation

poses an undue hardship. The following questions mayhelp determine effective

accommodations.

1. Do you have any suggestions regarding possible accommodations to improve job

performance? Yes ___ No___

a. If so, what are they?

2. How would your suggested accommodations improve the employee’s job performance?

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