Pregnancy-Related Informal Accommodation Reporting Form

 Pregnancy-Related Informal Accommodation Reporting Form 

The University of Wisconsin–Madison is committed to equal access and inclusion for people with access needs.
 

When To Complete This Form

Please complete this form for reporting approved, informal pregnancy-related reasonable accommodations for employees and applicants, as defined in UW-5101 Pregnancy-Related Reasonable Accommodations for Employees and Job Applicants. This form is not intended for making an accommodation request.

Is the change the employee or job applicant requests: 

✅small,

✅temporary,

✅and something that they can directly talk about with their supervisor or person directing their work?

If yes, the request can be approved by the supervisor or person directing the work as an informal pregnancy-related reasonable accommodation. If no, contact your DDR. 

Informal accommodations can be provided for pregnancy or related medical conditions, without going through the formal process, when:

• the situation and need for accommodation is obvious,
• and the employee confirms their limitation and their need for adjustment or change at work because of the limitation,  
• and the request and adjustment is straightforward and easy to provide.

After this form is submitted, the Employee Disability Resources (EDR) Office will notify confirmation of the informal accommodation to the employee, direct supervisor, and the Divisional Disability Representative (DDR). This form and related information will remain in a confidential file, separate from the employee's personnel file. 

When To Contact Your DDR

Please contact your DDR to have a confidential conversation if your situation is one of the scenarios below. They will help guide you through the next appropriate steps for your individual situation. You may also contact the EDR office directly. 

Contact your DDR if:

• you are requesting an accommodation that has not yet been approved;
• the pregnancy-related accommodation is not straightforward and/or easy to provide; 
• the employee making the request is not sure if the change is small, temporary, and/or they are not comfortable talking with their supervisor or person directing their work;
• the accommodation requested is disability-related only, not pregnancy-related; 
• or the employee has questions about making an accommodation request and wants to talk with someone first. 

When Things Change

If an employee or job applicant provides or arranges for their own adjustments without making a formal accommodation request, and the adjustment becomes disruptive in the workplace or recruitment/hiring process, violates university policies or related laws and regulations, or is otherwise unreasonable, the self-provided adjustment must be discontinued immediately, and the employee or job applicant must engage in the formal reasonable accommodation process with their DDR. 

Where To Learn More

This form aligns with UW-5101 Pregnancy-Related Reasonable Accommodation for Employees and Job Applicants, meets the reporting requirements under II. Informal Accommodation, and is submitted directly to the Employee Disability Resources office for notification and confidential record keeping purposes.