DoDEA

Follow these steps when an employee raises medical or environmental factors as a concern in job performance or conduct.

STEP 1

The employee/applicant completes Part I, Employee’s Statement of Disability. The requesting employee’s supervisor, or in the case of an applicant, the Personnel Director will review the form to determine if further action is necessary. Instruct the employee/applicant to use an additional piece of paper or the back of the form, if necessary, to completely answer the questions.

STEP 2

The supervisor/Personnel Director completes Part II, Supervisor’s Statement, to identify those performance, conduct or attendance problems the employee/applicant is experiencing.

STEP 3

The employee/applicant provides acceptable medical evidence to support his/her claim to the employee’s supervisor or Personnel Director, as appropriate. The supervisor/Personnel Director will provide Part III, Physicians Statement to the employee/applicant with a copy of the appropriate position/job description, performance elements and standards, and the physical and environmental factors identified for the position. Provide copies of Parts I and II to the physician, if appropriate.

STEP 4

Provided the medical evidence is sufficient, the appropriate supervisor/Personnel Director will complete Part IV, Agency Certification of Accommodation Efforts. If any accommodation is granted or denied, a copy of Part IV should be mailed or Faxed to the DoDEA Equal Employment Opportunity Office.

Mailing Address

• DoDEA Equal Employment Opportunity Office
• ATTN: Disabilities Program Manager
• 4040 North Fairfax Drive, Arlington, VA 22203-1634
  
  

FAX: (703) 696-9059.

DoDEA DMEO Pamphlet 01-EEO-01 Procedures to Facilitate the Provision of Reasonable Accommodation