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Accommodation denial form
Accommodation denial form
1
A
CC
OM
MO
D
A
TION
DE
N
IA
L
F
OR
M
Em
p
lo
y
ee
N
ame:
Dat
e
of De
ni
al:
A
c
c
o
m
m
o
da
ti
o
n(s)
Den
ie
d:
REA
SON
(S)
FOR
DEN
IA
L
(m
a
y
c
he
c
k
m
ore
th
a
n
on
e
bo
x)
A
c
c
o
m
m
od
ati
on
I
ne
ffe
c
ti
v
e
A
c
c
o
m
m
od
ati
on
W
ou
ld
Cau
s
e U
n
du
e
H
ard
s
h
ip
M
ed
ical
Docum
e
nta
tio
n
I
na
de
qu
at
e
A
c
c
o
m
m
od
ati
on
W
ou
ld
Req
ui
re
R
e
m
ov
al
of
an
Es
s
e
nti
al
Fu
nc
ti
on
A
c
c
o
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m
od
ati
on
W
ou
ld
Req
ui
re
Lo
w
e
rin
g
of
Perf
orm
a
nc
e
or Pro
du
c
ti
on
Sta
nd
ard
Othe
r:
DET
A
ILED
REA
SO
N(S) F
O
R
T
H
E
D
ENIA
L OF
A
CC
OM
M
O
DA
T
ION
NEXT
ST
EPS
Pro
vi
de
A
dd
iti
on
al
I
n
fo
rm
ati
on
M
ee
t
to
Dis
cus
s
Oth
e
r
A
c
c
omm
od
ati
on
O
p
tio
ns
Ex
pl
o
re
R
e
as
s
i
gn
m
e
n
t
Te
rm
in
at
e
Em
pl
oy
m
en
t
Othe
r:
CO
M
M
ENTS
SIGNA
T
UR
ES
Em
p
lo
y
er Re
p
resen
tat
iv
e:
Dat
e:
Em
p
lo
y
ee
:
Dat
e:
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Accommodation denial form
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