Employee Disability Accommodation Request

This form is considered confidential and is maintained separately from the employee’s personnel records. For questions, please email or call 410-704-2162


My Request is for a

Medical documentation from a treating medical provider will be required. Please have your medical provider complete the ADA Medical Certification Form. The documentation must indicate the anticipated duration of the need for accommodation, the medical restrictions the  condition presents, and any suggested accommodations. Additional documentation may be requested as part of the interactive process.