Workplace Accommodation Record of Action Form

If supervisor and employee have come to an informal agreement regarding the provision of a workplace accommodation, please fill out a copy of this form and submit it to the University of Alaska Human Resources ADA Accessibility Team at Please upload additional documentation at the same link if necessary.

The ADA Accessibility Team retains records of informal accommodations in order to better transition employees between different supervisors, and to better serve future employees who request accommodations.

Workplace Modification Record of Action Form 

Need additional help or have questions?

Please contact for additional assistance.  

To contact other UA HR teams, please visit our Contact Us page at


Article ID: 860
Wed 6/15/22 8:45 AM
Wed 12/13/23 2:54 PM