Reasonable adjustment request template

Template for an employee to ask their employer for a reasonable adjustment. Free to use.

Reasonable adjustments are changes an employer makes to remove or reduce a disadvantage related to someone's disability. A disability can be a physical or mental health condition.

Find out more about making a request for reasonable adjustments

You can copy and paste the template text into an email or document.

Template

[Today's date]

Dear [name of manager / employer / HR manager],

I'm writing to make a reasonable adjustment request to help me manage my health at work.

[Give details of how your health affects work. Or how your work affects your health. You do not need to share your disability, but it can help your employer understand your needs. For example:

  • I've been diagnosed with anxiety
  • I'm receiving treatment for my mental health condition
  • I have arthritis in my knees which makes it difficult to use public transport to get to the workplace
  • I'm receiving cancer treatment]

My current working pattern and role is [give details].

To help me manage my work and health I ask that [give details of what adjustments you would find helpful and why. For example, starting and finish an hour later to miss rush hour and reduce anxiety when travelling to work].

This would mean that I can [give details of any benefits to the employer. For example, feeling calmer when I start and end work, so I can focus better].

To deal with any effects the change could have on my work or the organisation, I suggest [give details of how you and your employer could deal with any effects. For example, someone in the team will pick up client calls before I start work, and I'll respond when I get in].

Please could we meet to talk about my reasonable adjustment request.

I look forward to your reply.

Yours sincerely,

[Your name]

Download this template

If you need the template in a different format, email digital@acas.org.uk

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