Page 1 of 3
Accomodation Request @ Onboarding
Employee ID#
*
Employee Name
*
Accommodations you are requesting?
*
Accommodations you are requesting?
Air Cleaners & Purifiers
Masks – General/Chemical/Allergen
Fans / Air Conditioner Use
Time off for Counseling / Therapy
Support animal or person of persons choosing. ** The support person does not have to be employed by the church or be located in New York State.
Electronic appointment scheduling
Electronic calendar
Electronic to-do list
Headset or earbuds
Noise Canceling Headphones
Notepad or White Board
Checklists
Physical/Social Distancing Signage
Rest Area/Private Space
Personal mobility devices (CANE, WALKER, WHEELCHAIR)
Telepresence or Teleworking, Work from Home, Working Remotely
Worksite Redesign / Modified Workspace
Training Refreshers
Periodic Rest Breaks on a Modified Break Schedule
Flexible Schedule
Medication Reminders
Uninterrupted Off and On Work Time
Sealed Food and Beverages Allowed at Workstations
Mini Refrigerators/ Electric Cooler Access
Something Else
If something else was checked above, please explain in detail
Next