City of Pittsburgh
Americans with Disabilities Act – Accommodation Request Form
ADA Coordinator’s Office, Department of City Planning
This Request for Accommodation form was established to meet the requirements of the Americans with Disabilities Act of 1990 (ADA), as amended. The Americans with Disabilities Act is a federal civil rights law that provides people with disabilities equal access to employment, state and local government programs, goods and services. The City of Pittsburgh is committed to making programs, services, and facilities accessible to all people. Under Title II of the ADA, the City of Pittsburgh is required to ensure that our facilities, services and programs are accessible to people with disabilities and in compliance with the ADA. The City will not place a surcharge on a particular individual with a disability or any group of individuals with disabilities to cover the cost of providing auxiliary aids/services or reasonable modifications of policy.
Alternative means of filing complaints, such as personal interviews or a tape recording of the complaint will be made available for persons with disabilities upon request.
*Attention, those planning to submit an accommodations request or grievance form by US mail:
COVID-19 Change of Procedure: To submit an accommodations request or grievance form, please email TBD. Mail is not being received in the office at this time. If you are unable to use this method, please contact the ADA Coordinator to request an accommodation.
Accommodation Policy
If the ADA Coordinator is able to grant the accommodation, the petitioner will be notified within 5 business days of receipt of the request and no further action will be required by the petitioner. The request will then be implemented by the appropriate City Department.
If the ADA Coordinator is unable to grant the accommodation request, the petitioner will be notified of the decision, along with his/her rights to file a grievance under the City’s Grievance Procedure, in a format acceptable to the petitioner.
ADA Accommodation Request Form
Instructions: Please fill out the form completely. Once you have done so, please hit “submit.” If a required field does not apply, please enter “N/A.” If you do not know the information under required filed, please enter “unknown.”
According to the Equal Employment Opportunity Commission (EEOC), when an individual decides to request an accommodation, the individual or his/her representative must let the employer know that s/he needs an adjustment or change at work for a reason related to a medical condition. There is no need to mention the ADA or use the phrase “reasonable accommodation.”
Requests for reasonable accommodation do not have to be in writing and can be requested in a face-to-face conversation or using any other method of communication. Employers may choose to write a memo or letter confirming the employee’s request or may ask the employee to fill out a form or submit the request in written form. However, the employee may want to put the request in writing even if the employer does not require it. Sometimes it is useful to have a paper trail in case there is a dispute about whether or when the accommodation was requested.
Example A: An employee tells her supervisor, "I'm having trouble getting to work at my scheduled starting time because of medical treatments I'm undergoing." This is a request for a reasonable accommodation.
Example B: A new employee, who uses a wheelchair, informs the employer that her wheelchair cannot fit under the desk in her office. This is a request for reasonable accommodation.
Incorrect Example C: An employee tells his supervisor that he would like a new chair because his present one is uncomfortable. Although this is a request for a change at work, his statement is insufficient to put the employer on notice that he is requesting reasonable accommodation. He does not link his need for the new chair with a medical condition.
While an employer cannot ignore the initial request, this request does not necessarily mean that the employer is required to provide the change. A request for reasonable accommodation is the first step in an informal, interactive process between the employee and the employer. In some instances, before addressing the merits of the accommodation request, the employer needs to determine if the individual's medical condition meets the ADA definition of "disability," a prerequisite for the individual to be entitled to a reasonable accommodation.
For additional information, take a look at the following resources:
FAQ: What are the limitations on the obligation to make a reasonable accommodation?
FAQ: What does the term “readily achievable” mean?
FAQ: How is the term “readily achievable” determined in a multi site business?
FAQ: When barrier removal is not readily achievable, what kinds of alternative steps are required by the ADA?
Fact Sheet: Reasonable Accommodations in the Workplace
Fact Sheet: Small Business and ADA Readily Achievable Requirements