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Request to your employer for reasonable adjustments (Great Britain)
England, Scotland and Wales · in English · for employees
€2.00This document is sold blank, to print and complete by hand.
Made for use in England, Scotland and Wales
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This document is sold blank, to print and complete by hand.
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For a worker in England, Wales or Scotland with a disability or long-term health condition who needs changes at work — equipment, hours, duties, the workplace, how meetings are run: a letter asking the employer to make reasonable adjustments under section 20 of the Equality Act 2010, describing the difficulty at work (not a diagnosis) and the changes asked for, and offering a meeting or an occupational health referral. Access to Work, a free government scheme, can also help. Hand it in and email it. Sold blank, to complete by hand, as it holds health data DocMuse does not collect.
- Made for use in England, Scotland and Wales
- Last updated October 29, 2026
- Document in English
Where a UK document reproduces the words of legislation or of a government publication — UK, Scottish or Northern Irish — it contains public sector information licensed under the Open Government Licence v3.0.
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When to use this document
- You have a long-term health condition and need a special chair and breaks at work in England.
- After a long period off sick you want a phased return with shorter hours.
- Your employer has ignored your spoken request for changes and you want to put it in writing.
- You want to ask for reasonable adjustments at work in Wales or Scotland without naming your diagnosis.
What you fill in
The details the document asks for.
- Employee
- Employee's address
- Town or city
- Employee's postcode
- Date
- Person at your employer you are writing to, as you would greet them (e.g. Priya Patel)
- Employer
- Employer's postal address (street and number, postcode and town on separate lines)
- The difficulty you have at work (its effect; you need not name a diagnosis)
- Adjustments requested
- Anything else you want to add (optional)
Common questions
- When must an employer in Great Britain make reasonable adjustments?
- When a worker or job applicant is disabled under the Equality Act 2010 — a physical or mental impairment with a substantial and long-term adverse effect on normal day-to-day activities, with some conditions such as cancer covered from diagnosis — and the employer knows, or could reasonably be expected to know, of it. The employer must take the steps that are reasonable to remove the disadvantage, and cannot charge the worker for them.
- What is Access to Work, and does it replace the employer's duty?
- Access to Work is a free government scheme run by the Department for Work and Pensions that can pay for practical support at work — special equipment, a support worker, help with travel to work, mental health support — beyond what is reasonable for the employer to provide. You apply yourself, online. It does not replace the employer's duty to make the adjustments that are reasonable for it to make.
- What can I do if my employer refuses reasonable adjustments?
- Ask for the reasons in writing and raise a formal grievance. The Equality Advisory and Support Service runs a free helpline, and Acas gives free advice. A failure to make reasonable adjustments is disability discrimination: a tribunal claim, after Acas early conciliation, must generally start within six months less one day for acts or failures from 1 October 2026. Keep a record of what you asked for and when.
How you can sign this document
- Print it and sign by hand. The signature lines in the document are left blank on purpose — sign on them in ink.
- Sign it yourself with a qualified electronic signature. If you already hold a QES — Evrotrust, B-Trust, StampIT, ZealiD or any qualified provider on the EU Trusted List, on a card, a USB token, in a mobile app or in the cloud — our signing guide explains step by step how to sign this exact file without invalidating it. Step-by-step help, and a way to check it worked
DocMuse sells documents, not legal advice. Acceptance always depends on the recipient's rules and your local law.
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