The State of Colorado requires employers to provide reasonable accommodations to employees with health conditions related to pregnancy or physical recovery from childbirth. This form is an initial step in processing your request for an accommodation. Examples of reasonable accommodations include but are not limited to: more frequent or longer breaks, obtaining or modifying equipment or seating, temporary transfer to a less strenuous or hazardous position, if available (with return to the current position after pregnancy), light duty (if available), job restructuring, limiting lifting, assistance with manual labor or modified work schedules.
Please be advised that medical documentation may also be requested by ADA Compliance in order to support our request. The ADA requires that ADA Compliance keep medical information confidential. However, the law allows the ADA Compliance to share information regarding your medical information in limited circumstances with individuals who are considered to have a legitimate need to know this information. These persons can include your supervisor(s), human resources personnel, first aid and safety personnel, personnel investigating compliance with the ADA, and other persons considered to have a legitimate need to know. The law does not prohibit you from voluntarily discussing your condition or medical information with others.
Please submit the completed form below.