ADA Accommodations for City Employees


​The City of Salem will not discriminate against qualified individuals with disabilities, on the basis of their disability, in employment or employment practices. The City shall engage in an interactive process when a need is identified or an accommodation is requested.

The following table provides employees a list of key information you will need to answer in order to provide Human Resources (HR) with sufficient information to continue processing the accommodation request. The information is designed for an employee to participate in an interactive discussion with HR after you have completed the requested form and submitted it to HR.

Accommodation request

​1. ​What specific accommodation are you requesting?
​2. ​If you are not sure what accommodation is needed, do you have any suggestions/options to explore?
​3. ​Is your request time sensitive?
​4. ​What, if any, job function are you having difficulty performing?
​5. ​What, if any, employment benefit are you having difficulty accessing?
​6. What limitation is interfering with your ability to perform your job or access employment benefit?​
​7. ​Have you had any accommodations in the past for this same limitation?
​8. ​If you are requesting a specific accommodation, how will that accommodation assist you?
​9. ​Please provide any additional information that might be useful in processing your accommodation request.


It is important to remember you should provide as much detail as possible in order to ensure timely processing of your request.

Medical provider inquiry request form

Once you have completed the ADA request for accommodation form (HR 034), HR may contact you or your medical provider to fill out the required medical documentation and return to your HR Analyst continue processing the accommodation.

Employee ADA Medical Provider Inquiry following Form (HR 035)


HR 034ADA Employee Request for Accommodation form1240 KBhr-034-employee-request-for-accommodation-form-ada.pdf
HR 035ADA Medical Provider Inquiry form1240 KBhr-035-medical-provider-inquiry-form-ada.pdf

Contact us

Human Resources Department
8:00 a.m.–5:00 p.m.
295 Church ST SE Suite 210
Salem OR 97301