| Title | Date | Was Interactive Process Observed | Comments |
|---|---|---|---|
| Documentation Request | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not unnecessarily request full medical records.
|
Comments: |
| Explain Need | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not explain why documentation was needed.
|
Comments: |
| No Documentation for Obvious Cases | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not request documentation when need was obvious.
|
Comments: |
| Job Description Consultation | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not consult the job description.
|
Comments: |
| Essential Functions Missing | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not include essential functions in job description.
|
Comments: |
| Inclusive Job Descriptions | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not provide inclusive job descriptions.
|
Comments: |
| Employee Questions | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not encourage employee questions.
|
Comments: |
| Confidentiality Assurance | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not assure confidentiality of medical info.
|
Comments: |
| Separate Medical Files | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not store medical info separately.
|
Comments: |
| Safety Info Sharing | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not share info with safety personnel.
|
Comments: |
| Supervisor Sharing | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not inform supervisors about accommodations.
|
Comments: |
| Compliance Investigation Info | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not share info for compliance investigations.
|
Comments: |
| Necessary Info Only | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not request only necessary info.
|
Comments: |
| Explore Options | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not explore accommodation options.
|
Comments: |
| Employee Ideas | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not consider employee's accommodation ideas.
|
Comments: |
| Outside Sources | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not consult outside sources.
|
Comments: |
| Medical Provider Recommendations | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not consider medical provider recommendations.
|
Comments: |
| VR Services | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not utilize VR services.
|
Comments: |
| JAN Guidance | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not follow JAN guidance.
|
Comments: |
| ADA Network Guidance | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not follow ADA Network guidance.
|
Comments: |
| Effectiveness Determination | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not determine the effectiveness of options.
|
Comments: |
| Employer-Selected Option | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Disregarded employee's preference for accommodation.
|
Comments: |
| Trial Period Agreement | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not consider a trial period for accommodations.
|
Comments: |
| Employer Choice Communication | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not discuss the chosen accommodation with the employee.
|
Comments: |
| Employee Questions | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not encourage employee questions.
|
Comments: |
| Consultation of Job Descriptions | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not consult job descriptions.
|
Comments: |
| Role of VR Services | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not utilize VR services.
|
Comments: |
| Outside Source Guidance | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not seek outside source guidance.
|
Comments: |
| Job Accommodation Network | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not follow JAN recommendations.
|
Comments: |
| Preferred Communication Method | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not respect preferred communication method.
|
Comments: |
| Privacy and Confidentiality | Date: ___________ |
Yes No NA The employer did not demonstrate this interactive process. Did not maintain privacy and confidentiality of medical records.
|
Comments: |