This checklist follows the EEOC's recommended method for determining what accommodation may be appropriate when an individual with a disability is unable to perform a job function because of the disability.
Applicant Name: Susan Master
Job Title: Data Entry Clerk
Completed By: ___________________________
District: _________________________________
Date: _______________
ANALYZE THE JOB
What is the purpose of the job?
To enter employee information into computer system.
List all the essential functions (use additional page if necessary)
Must be able to keyenter data using the keyboard. Must be able to verify data is correct before processing.
CONSULT THE INDIVIDUAL
What essential function(s) is/are the individual unable to perform?
Cannot bend neck to view monitor in order to verify correct employee information.
Why? (Identify job-related physical or mental limitations)
Has scoliosis. This condition prevents applicant from bending neck.
Can the individual suggest an accommodation? What?
Suggests that we raise desk or monitor to eye level.
Note: If the individual suggests an appropriate accommodation, you may stop here. If not, or if you wish to consider alternatives, continue on next page.
IDENTIFY POSSIBLE ACCOMMODATIONS
Contact sources such as state or local rehabilitation agencies, disability organizations, the Job Accommodation Network, and the Equal Opportunity Commission.
Source Contacted __________________________________________
__________________________________________________________
___________________________________________________________
Recommendations (attach additional sheet if necessary)
__________________________________________________________
__________________________________________________________
__________________________________________________________
Assess the effectiveness of each accommodation identified.
Accommodation
__________________________________________________________
__________________________________________________________
__________________________________________________________
Effective (yes/no? Give reason)
__________________________________________________________
__________________________________________________________
__________________________________________________________
SELECT THE MOST APPROPRIATE ACCOMMODATION
Note: Be sure to consider the individual's preference; however, the employer has the ultimate discretion to choose among effective accommodations.
Which accommodation is most appropriate (explain):
__________________________________________________________
__________________________________________________________
__________________________________________________________
Accommodation implemented (date):____________________
Accommodation not implemented (explain):
__________________________________________________________
__________________________________________________________
__________________________________________________________
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Area Human Resources Representative:* Paul Jones
Date: 3-28-92
Employment Manager:*__________________________________
Date: ________________
District Human Resources Manager:*__________________________
Date: ________________
* It is the responsibility of Human Resources to ensure that all necessary consultations and approvals have been made.
** If facility requires alteration, please attach appropriate documentation.