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Graphic showing the ADA Accommodation Denial FormGraphic showing the ADA Accommodation Denial Form
Graphic showing the ADA Accommodation Denial Form

ADA Accommodations Denial Form [Free Template] — Do’s and Don’ts, Included

TL;DR: This ADA Accommodation Denial form template documents the details of an employee's denied request for workplace accommodation under the ADA, including specific reasons for the denial and subsequent steps to be taken by the employer and employee. It also includes sections for detailed explanations and alternative solutions and requires signatures from both parties to acknowledge the decision.

Team Disclo
March 26, 2024

Before you get started, refer to these do's and don'ts before reviewing and downloading this template:


Do Document Everything: Keep detailed records of the accommodation request, notes of all conversations related to the review and decision, any documents received and the reasons for denial.

Do Be Specific: Clearly state why the requested accommodation was denied. Provide concrete examples and refer to legitimate reasons related to the job or the company's operations.

Do Maintain Confidentiality: Protect the employee's privacy by sharing information only with those who need to know.

Do Offer Alternatives: Whenever possible, suggest alternative accommodations that might be more feasible for the company to provide or would support the employee in performing the essential functions of their job. 

Do Engage in an Interactive Process: The denial of an accommodation should always come after a thorough interactive process that includes multiple discussion between the employee and the company, with the goal of finding a workable solution.

Do Provide a Reasonable Explanation: Justify the denial based on legitimate business reasons, such as undue hardship, removal of essential functions of the job or reduction of performance standards.

Do Review Company Policies: Ensure that the denial aligns with company policies and ADA guidelines.

Do Advise on the Appeal Process: Inform the employee of their rights and the process to appeal the decision if they wish to pursue it.

Do Sign and Date: Make sure the form is signed and dated by the appropriate representatives.


Don't Make Quick Judgments: Avoid denying a request without thoroughly reviewing it, considering all the facts and having a discussion with the employee about the request and any potential alternate accommodations.

Don't Discriminate: Never deny an accommodation based on discriminatory reasons.

Don't Forget to Consult: Consult with HR, legal counsel, or ADA experts when in doubt about the accommodation request or denial.

Don't Provide Vague Reasons: Avoid general statements like "it just won't work" without providing a specific, job-related basis for the denial.

Don't Disregard Employee Input: The employee's perspective on what they need should be seriously considered.

Don't Neglect Training: Ensure that those involved in the accommodation process are trained on ADA compliance.

Don't Deny Out of Convenience: Don't deny a request just because it may be inconvenient or because there's a preference for things to stay as they are.

Don't Ignore Possible Solutions: Do not fail to consider potential solutions that may be a compromise for both the employee and the employer.

Don't Miss Deadlines: Respond to accommodation requests in a timely manner to avoid unnecessary delays.

By following these do's and don'ts, employers can better ensure they are complying with ADA regulations, acting fairly, and maintaining a respectful workplace while also protecting the company from potential legal issues.

This template is designed to be comprehensive and ensures that all necessary information is captured to make an informed decision while also providing clear next steps and the option for the employee to appeal the decision. Please customize the sections as necessary to fit your company's procedures and policies.


ADA Accommodation Denial Form

[Company Name]

ADA Accommodation Denial Form

Employee Information (make a table, like other forms)

Employee Name: __________________________   Employee ID: ___________________________

Department: ____________________________  Position: _____________________________

Accommodation Request Details

  • Accommodation(s) Requested:
  • Alternate Accommodation(s) Considered, if any:


  • Date of Initial Request: ____________________
  • Date(s) of Review: ___________________________
  • Date of Denial: __________________________


  • Accommodation(s) Denied:

Reason(s) for Denial (Please check all that apply and provide a brief explanation if necessary)

make check boxes

__ Accommodation Not Effective (Explanation):

__  Accommodation Would Cause Undue Hardship (Explanation):

__ Medical Documentation Inadequate (Explanation):

__ Accommodation Requires Removal of an Essential Function (Explanation):

__ Accommodation Requires Lowering Performance or Production Standards (Explanation):

__ Other (Please specify):

Detailed Reason(s) for the Denial of Accommodation

Next Steps (Please check all that apply) 

make check boxes

  • Provide Additional Information by: ________________________
  • Meet to Discuss Other Accommodation Options on: ___________
  • Explore Reassignment Opportunities
  • Initiate Interactive Process Again
  • Other (Please specify):


(Additional notes or comments regarding the decision or process)


  • Employer Representative: ________________________ Date: __________
  • Employee: ________________________ Date: __________

This decision may be appealed in accordance with [Company Name]'s grievance procedures or by contacting the Equal Employment Opportunity Commission (EEOC).


Want to access the PDF version?


About Disclo

Built by 2x disability-focused founders, the software is a workplace ADA and PWFA accommodations platform for progressive companies focused on making workplaces inclusive for everyone. Disclo is a HIPAA-compliant platform that requests, tracks, and manages workplace accommodations—all in one place. 

Disclo makes handling accommodations seamless by combining automation, in-app medical e-verification, out-of-the-box analytics (so you can auto-track against EEOC and ADA standards), and the ability to connect to any HRIS and ATS with pre-built integrations.

Strengthen workplace inclusivity and future-proof ADA and PWFA processes while establishing a digital paper trail for your organization. Learn more at

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