Telecommuting Accessibility Assessment Form

Personal Information

Full Name Position/Title Department

Workspace Assessment

Describe your current telecommuting workspace Do you have a private, quiet space to work? Yes No Is your workspace ergonomically suitable for your needs? Yes No

Technology and Equipment

Do you have reliable internet access? Yes No List devices (computer, phone, etc.) available for telecommuting Do you have access to necessary software and applications? Yes No

Accessibility Needs

Do you require reasonable accommodations to telecommute effectively? Yes No If yes, please describe the accommodations or adjustments needed

Comments or Concerns

Additional information or concerns