Workplace Accommodation for Neurodivergence

Workplace Accommodation for Neurodivergence — Form Fields

This hr template includes 11 fields. Accommodation request for neurodivergent employees seeking workplace adjustments. Free to customize and use on ZenBuild.

• Employee Name (text, required)
• Work Email (email, required)
• Department (text, required)
• Job Title (text, required)
• Condition (optional to specify) (dropdown selection, optional) — options: ADHD, Autism Spectrum, Dyslexia, Dyspraxia, Tourette's, Prefer Not to Say, Other
• Workplace Adjustments Requested (checkboxes, required) — options: Noise-Canceling Headphones, Quiet Workspace, Flexible Schedule, Written Instructions (vs verbal), Reduced Fluorescent Lighting, Structured Breaks, Screen Reader/Assistive Tech, Modified Meeting Format, Task Management Tools
• Communication Preferences (checkboxes, optional) — options: Written Over Verbal, Advance Agenda for Meetings, One-on-One Over Group, Email Over Phone, Clear Deadlines in Writing
• Describe How Adjustments Would Help (long text, required)
• Medical Documentation Available (multiple choice, optional) — options: Yes, No, Can Obtain
• Healthcare Provider Name (optional) (text, optional)
• Additional Context (long text, optional)