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Get Reasonable Accommodation Verification Form

D? â–¡ â–¡ â–¡ â–¡ â–¡ â–¡ â–¡ â–¡ â–¡ â–¡ Caring for Self Interacting with others Performing Manual Tasks Breathing Working â–¡ â–¡ â–¡ â–¡ â–¡ Walking Standing Reaching Thinking Toileting â–¡ Yes Hearing Seeing Speaking Learning â–¡ â–¡ â–¡ â–¡ â–¡ No Lifting â–¡ Sleeping (describe) Other: Concentrating Reproduction Sitting 6. Does the impairment substantially limit the operation of a major bodily function? If yes, what major bodily function(s) is/are affected? â–¡ Yes â–¡ No .

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