Craft Health Request for Reasonable Accommodation

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This is a confidential form and will be submitted by the requesting applicant/employee directly to Human Resources

Name
Physician name. The physician may receive a letter/fax from us requesting information on your impairment/disability and recommendations for accommodations.
Physician address

[In non-physician review cases, decisions regarding accommodations will be made within 10 days of the receipt of this form by Human Resources. Due to delays that may be caused in communications with physicians, no specific decision date can be provided for physician review cases.]