Accommodation Requests, Medical Restrictions, Interactive-Process Communications and Return-to-Work Worksheet

Purpose#

A dated, source-linked record of accommodation requests, functional restrictions, medical-document requests, interactive-process exchanges, employer decisions, clearance submissions, actual scheduling and restoration to work. Build two separate tracks: (1) workplace accommodation needed while performing the job, and (2) medical leave/fitness/return clearance. A full-duty clearance may answer a fitness question but not necessarily resolve an independently requested schedule or work-method accommodation. Conversely, a clearance without restrictions may be relevant to whether any additional accommodation is medically supported. Record the contemporaneous evidence for each question rather than assuming either conclusion.

Blank-form protocol: assign neutral source IDs (e.g., DOC-001), preserve native versions and exact timestamps, and record whether every proposition is a firsthand observation, document content, party assertion, or inference. Create no names, clinical results, accommodation approvals or events merely to fill a template.

The six-way records key#

Mark every document with one letter:

• H — lawfully in the user's possession; record its source and authorization. Having a copy does not make every use or disclosure lawful.
• R — potentially requestable, subject to the scope and conditions of the particular statute. Personnel-file access (Labor Code §1198.5), wage-record access (§226), signed employment instruments (§432), and the patient's own health records (Health & Saf. Code §123110 and applicable exceptions) are separate regimes; no single request covers everything. EDD personal wage-information access under Unemployment Insurance Code §1094(e) is not unrestricted access to confidential employer submissions. See Roadmap 104.
• D — candidate for appropriately scoped agency investigation, litigation discovery, subpoena or other lawful process; production is not guaranteed and may require objections and protective orders.
• P — potentially privileged, exempt or sensitive; record only its existence, lawful public identifier, custodian, and basis for concern. Peer review, counsel communications and other persons' medical records call for individualized analysis.
• K — preserve through a lawful request to the responsible custodian, without suggesting voluntary production is mandatory or that sanctions automatically follow nonproduction.
• X — prohibited or unauthorized access/copying, including patient charts and restricted employer or jail systems. Do not attempt access to verify a suspicion.

Requests and restrictions#

Timing rule: the date written on a certificate is not evidence that the employer received it on that date. A calendar event is not proof a meeting occurred. Track portals, certified messages, secure fax confirmations, delivery failures, bounced emails and proof of actual access separately.

Interactive-process communications#

No ritualized-form assumption. The California Civil Rights Department confirms that its accommodation sample forms are optional. An accommodation request should be tracked when actually made, whether orally, by email, through a supervisor, or on a particular employer form. Separately record whether the recipient understood the request and what additional information was reasonably needed. Formal submission and substantive notice are not interchangeable. The employer may be entitled to reasonable medical documentation when disability/need is not obvious or adequately documented; the employee also has cooperation obligations. 2 Cal. Code Regs. §11069(a)–(d).

Return to work#

A medical statement saying “full duty” is not itself proof of assignment, payment, credentialing, appointment or employer action. Conversely, a records gap showing no payroll entry is not by itself proof of no work, deliberate exclusion or a particular employer's decision. Distinguish medical clearance, administrative clearance, actual work opportunity and actual paid time, then match each to documentary evidence.

Instructions and cautions#

Keep provider records in a restricted medical annex, not in a shareable chronology. Report only work-related restrictions and evidence that a document was furnished. Do not record another employee's diagnosis or patient information. Roadmaps 014–017 supply legal frameworks; this worksheet does not decide whether a condition is a disability or an accommodation is reasonable.

Employer identity and decision-chain capture

For each event, identify the documented employer, payroll company, contracting professional corporation, management-services company, county client and individual actor separately. Record source and date for each asserted relationship. A W-2 label, email domain, management title, benefits administrator or county contract can be relevant without proving final control over accommodation and work assignments. Do not conflate who requested documentation, who reviewed it medically, who decided whether it was sufficient, who approved a schedule, and who implemented the schedule.

Comparative trace: where a document bears one entity name but payroll/benefits/government records bear another, preserve both, their applicable dates, the originals, amendments and alternative explanations. A later correction does not itself prove the earlier entry was fraudulent. Do not assign corporate or clinical authority based only on branding.

Track functions, restrictions and responses separately#

A medical diagnosis, a restriction on an activity, a workplace function and a requested adjustment are four different facts. A form may name a condition without stating any work restriction; a note may list restrictions without deciding whether a particular job function is essential. Enter those fields separately. Do not ask the worksheet to decide whether a person is disabled or whether an employer complied with a statute; those are legal and factual evaluations outside its function.

Adverse check: a treating provider's opinion need not decide which functions are legally “essential.” Identify the contemporaneous job description, actual assignment pattern, coworkers' roles, time spent on task, safety implications and employer assessment. FEHA regulations identify relevant essential-function evidence; the employer's job description is important but not necessarily conclusive. 2 Cal. Code Regs. §11065(e).

Use minimum medically necessary information. State in the main chronology that a certificate was sent, the dated functional restriction or clearance it communicated, and who actually received it. Keep diagnoses and treatment narratives in a separate protected annex. When two clinicians describe different restrictions, identify whether they address the same job, time, and question; a later evaluation need not retroactively invalidate an earlier one.

Documentation sufficiency test (California and ADA)

Under 2 Cal. Code Regs. §11069(c)(2), (c)(5), (c)(6) and (d), when the disability or need is not obvious and reasonable documentation has not already been furnished, the employer may request reasonable medical documentation. The source should substantiate a FEHA disability and explain the need for accommodation; where relevant it should identify functional limitations affecting essential job functions. The regulation does not generally authorize unrelated or complete medical records. When initial documentation is considered insufficient, identify the employer's specific stated insufficiency, the opportunity offered for timely supplemental information, any supplemental submissions, and any objective concern about the provider's competence or credibility. The employer may require assessment by an appropriate employer-selected provider in the specified circumstances, but applicable job-relatedness and cost rules remain. This is not a rule that every treating clinician's letter is automatically sufficient or that an employer can demand unlimited new forms.

Disputed paperwork sequence: compare the employer's blank form, the actual signed provider response, any later form, and what the employer asked for after receiving it. Track whether an additional document supplied material missing functional information or simply repeated previously provided facts. Neither the use of an employer's template nor the employee's preferred form alone decides statutory sufficiency. Preserve evidence of whether a genuinely effective alternative accommodation was considered while clarification remained pending.

Under 42 U.S.C. §12112(d)(4) and 29 C.F.R. §1630.14(c), an employee medical examination or disability-related inquiry generally requires a job-related/business-necessity basis; reasonable follow-up to a nonobvious accommodation need is a separate recognized context in EEOC guidance. Record objective work-related evidence offered for the inquiry, its scope, its duration and whether the employer's physician was proposed only after a documentation insufficiency. California §11069(c)(7)–(8) separately addresses the scope of employer-selected examinations and who bears their costs. Keep medical information in a separate confidential record; only documented restrictions and necessary accommodations should be routed to management, subject to applicable exceptions.

Record each employer response as documented: approved, offered an alternative, requested narrow clarification, deferred, rejected, or no response located. Preserve meeting invitations separately from evidence the meeting actually occurred. “No response found in this collection” is not proof that no response was sent. An alternative offered by the employer should be assessed for actual effectiveness, not rejected merely because it differs from the employee's preference. California §11068(e) and federal guidance allow a qualifying effective alternative, absent undue hardship.

For a schedule accommodation, distinguish agreed arrival/departure flexibility, preapproved leave, intermittent unforeseen absences and a proposal to excuse an essential duty. An employer may identify legitimate staffing and safety constraints but should tie them to the particular job and proposed accommodation. Under Samper v. Providence St. Vincent Medical Center, 675 F.3d 1233 (9th Cir. 2012), dependable attendance was essential for that NICU nursing role; that holding is not a blanket rule that every schedule adjustment in every clinical role is unreasonable. Capture actual staffing coverage and prior successful operation under the adjustment rather than extrapolating from job titles.

When an accommodation changes, preserve a distinct start date, effective period, renewal, and any clear termination notice. An informal prior practice does not prove it was permanent; a recently requested change must not be backdated to make it look continuous. Under 2 Cal. Code Regs. §11068(i), an employer generally may not impose a “100 percent healed” rule without an individualized assessment. That does not mean a specific functional clearance is always conclusive or that safety-critical roles are exempt from evidence-based assessments.

Four-step work restoration test: (1) medically eligible for specified tasks, (2) organizational approval/credentialing and system access, (3) actual shifts/hours made available and performed, (4) pay/benefits recorded. For each, note whether evidence is direct, circumstantial or absent. Separately preserve hiring/replacement requisitions with posting dates and approval chains; their existence alone does not prove a discriminatory motive or an actual job vacancy.

Trace the exact evidence chain. A signed note that stayed with the treating clinician was not necessarily furnished to the employer. Preserve creation/signature, upload or dispatch, proof of delivery, human acknowledgment, request for clarification, and decision. A later full-duty clearance can address a new time period and still leave a separately requested accommodation unresolved. If job duties, location, appointment status or supervisor changed, attach a contemporaneous dated reference, not a reconstructed assumption.

Adversarial test: explanations that must be preserved

• Insufficient documentation: Was there an objectively identifiable gap in disability/functional need, and did the employer explain it and permit a supplement as California §11069(c)(5)(C) contemplates? Were later requests tailored to the unresolved gap?
• Employee cooperation: Were requests received, deadlines reasonable, and employee/clinician responses transmitted? Identify objective refusals, delays, unread messages or misunderstandings without assuming bad faith.
• Effective alternative / undue hardship: Was there a feasible alternative that addressed the restriction, or specific staffing, cost, patient safety or operational evidence supporting a hardship assertion? Generic inconvenience is not itself proven undue hardship; neither is employee preference decisive.
• Essential functions, punctuality and safety: Compare actual role requirements and availability of cover with the Samper healthcare-attendance analysis. Do not infer a nurse's NICU staffing facts apply automatically to a different physician or office role.
• Independent employer reason: Identify objective contemporaneous conduct/performance, administrative, credentialing, employment-status or restructuring reasons raised by the employer, including contrary records and their dates. Correlation and suspicion are not conclusions about motive.
• Proof of possible accommodation: Nealy v. City of Santa Monica, 234 Cal.App.4th 359 (2015), addresses the need for evidence of an available reasonable accommodation on its record; a process claim cannot be assumed to succeed merely because forms were exchanged. Wentworth v. Regents of the University of California (Cal. Ct. App., Sept. 30, 2024) illustrates both employer accommodation defenses and independent privacy concerns. The court's partial reversal on a separate privacy issue is not a finding of accommodation liability.

Important time-bound retaliation correction. Nealy's discussion that a mere accommodation request was not FEHA retaliation-protected predates Assembly Bill 987. Effective January 1, 2016, Government Code §12940(m)(2) expressly protects accommodation requests against retaliation whether or not granted. Castro-Ramirez v. Dependable Highway Express (2016) describes that supersession. Track the request, adverse action, decisionmaker knowledge and source-supported linkage separately; protected activity alone does not prove retaliation. Distinguish accommodation, interactive-process and retaliation theories rather than treating their elements as identical.

Evidence provenance and contradiction controls#

Evidence grades: A = dated primary document with authenticated transmission/receipt; B = primary text missing some provenance; C = credible firsthand recollection or secondary compilation; D = inference, contested interpretation, or inaccessible source. These are worksheet evidence grades, not judicial admissibility, legal-accuracy grades, or the project's final authority clearance. A cryptographic hash establishes byte identity of a particular copy, not the sender's identity, clinical truth, legal sufficiency or historical completeness.

For contradictory records, keep both. Do not edit an original email, certificate, payroll item, log or medical form to normalize spelling, date or entity name. Create a separately labeled transcription, exact quote with page/line, and correction note. Keep potentially privileged communications out of the public version. Do not draw adverse-inference conclusions merely because a document is missing; identify the custodian and lawful acquisition path.

Targeted legal reference and access register (not corpus-wide signoff)#

Source paths for verification (not website endorsements):

• California CRD: https://calcivilrights.ca.gov/accommodation/ (external site)
• California interactive process: https://www.law.cornell.edu/regulations/california/2-CCR-11069 (external site)
• California accommodation: https://www.law.cornell.edu/regulations/california/2-CCR-11068 (external site)
• California essential functions: https://www.law.cornell.edu/regulations/california/2-CCR-11065 (external site)
• FEHA text (2025 reproduction): https://law.justia.com/codes/california/code-gov/title-2/division-3/part-2-8/chapter-6/article-1/section-12940/ (external site)
• ADA medical inquiry statute: https://www.law.cornell.edu/uscode/text/42/12112 (external site) (42 U.S.C. §12112(d)(4))
• ADA regulations: https://www.law.cornell.edu/cfr/text/29/1630.2 (external site) and https://www.law.cornell.edu/cfr/text/29/1630.14 (external site)
• EEOC inquiry guidance: https://www.eeoc.gov/laws/guidance/enforcement-guidance-disability-related-inquiries-and-medical-examinations-employees (external site)
• Samper: https://law.justia.com/cases/federal/appellate-courts/ca9/10-35811/10-35811-2012-04-11.html (external site)
• Nealy: https://law.justia.com/cases/california/court-of-appeal/2015/b246634.html (external site)
• Castro-Ramirez: https://law.justia.com/cases/california/court-of-appeal/2016/b261165a.html (external site)
• Wentworth: https://law.justia.com/cases/california/court-of-appeal/2024/a168296.html (external site)

Nonpublication and review requirements#

This private candidate is a factual capture tool, not a determination of liability, defendant identity, available forum, exhaustion or deadline. The draft does not invent a computed deadline. Complete later-history/citator review, legal-currency authentication, document-body source-B reconciliation, privacy/privilege contextual screening, LEAP template integration, and outside counsel/clinical/editorial signoff remain OPEN. Mechanical absence of patient identifiers is not privacy approval.

It does not tell users whether a particular claim succeeds or whom to name. Those questions belong with the linked substantive Roadmaps and independently qualified counsel.

Related roadmaps#