This is the letter I wrote to my company, if it helps:

My Name
My address
My City, State, Zip


Reasonable accommodation request


Compnay Name
Department of Human Resources
Address
City, State, Zip


Re: Request for reasonable accommodation

Dear Company Name

I am a person with a physical disability which substantially impairs my ability to walk, sit or stand for long periods of time, and concentrate due to pain. I am employed as an Your Job Title at the Portland office. My disability makes it difficult for me to sit for long periods of time, sit around crowded tables, and focus on my work due to severe pain. My condition is considered chronic, and does qualify as a disability under The Americans with Disability Act.

The Americans with Disabilities Act requires an employer to provide reasonable accommodations to employees with disabilities. A reasonable accommodation is any modification or adjustment to a job, or to the work environment, that will allow a qualified individual with a disability to perform the essential functions of the job.

I am requesting, as a reasonable accommodation for my disability, that you allow me to be removed from the work area as needed, usually about once an hour, to allow me to relax, which helps reduce the pain and will allow me to more often work a full 8 hour day. I have found that going outside helps with the relaxation, as I am removed from the work area, not interrupting other employees, and have a stress free environment for a couple minutes. This also helps increase my mobility, as sitting for long periods of time without moving around increases my pain. My disability causes intense pain, and one of the keys to managing the pain is doing things in moderation and taking breaks to relax. A 3 minute break each hour would provide me the opportunity to work my full schedule on a more regular basis. I am also requesting to wear jeans on days that I have certain medical procedure done, within reason, so I do not ruin my work clothes. Certain medicated creams used can stain and destroy pants. I also request that any job duty that requires me to stand for more then 5 minutes I have some assistance with. Said assistance can be determined by the Company. During meetings I request that I be allowed to not sit at a crowded table, as my foot often gets kicked accidently underneath the table, and my condition causes severe allodynia, which causes severe sensitivity to the affected area. I also request that during meetings I be allowed to leave the area and take a break to relax and move my foot, without interruption or embarrassment to the meeting when it’s needed.

If necessary, I can provide a letter from doctor confirming my disability and the affect it has on my ability to walk, sit or stand for long periods of time, and concentrate due to pain. I am currently seeing a number of physicians, in varying specialties, and can document my diagnosis and condition if requested.

I also request that I not be discriminated against because my disability can make me “look” a certain way (i.e. a look on my face of pain should not be mistaken for an “attitude” problem). The pain caused by my disability can be very debilitating, and while I will make every possible effort to mask the pain, it is inevitable that it will show on my face occasionally. I have notified in writing my team and employees I work closely with of my condition, so that they are aware that despite what shows on my face that I am there to perform the functions of my job and that they should feel free to ask me any questions or approach me about work related matters without concern.

I do not believe that any of these accommodations would produce any undue hardship upon the company, nor would they interrupt the other employees in the function of their job duties. The accommodations above would give me a chance to achieve the same level of performance as an average person in the same position without a disability. The accommodations also do not interfere with any of the essential functions of my job.

I look forward to talking with you about my reasonable accommodation request and ways that my disability can be effectively accommodated so that I can continue to perform the essential functions of my job. Please respond to me in writing within 10 business days.

Thank you for your consideration and I look forward to receiving your reply.


Sincerely,


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