[DATE]
[Your Name]
[Your Address]
[Employer’s/Company Name]
[Employer’s/Company Address]
Dear [insert employer’s name here]
My name is ___(your name)__ and I have worked at __(company name)__ as a __(your position)__since (approximate date of hire). As you may know, I am currently living with a disability (Long COVID). I was diagnosed with COVID on __(approximate date of first diagnosis)___ and have continued experiencing symptoms substantially limiting my ability to work and participate in other major life activities.
I am experiencing the following difficulties in performing my job because of my disability: ____(difficulties in job performance)__. I am writing to request that workplace accommodations in the form of (requested accommodations). This/these accommodation(s) will better enable me to successfully perform my job. I ask that if you have alternative suggestions regarding reasonable accommodations, please share them with me so we can work together to find a workable and effective accommodation.
For more information about my rights and your responsibilities under the Americans with Disabilities Act, you can contact the Job Accommodation Network at 1-800-526-7234 or the Equal Employment Opportunity Commission at 1-800-669-4000. The Job Accommodation Network also provides examples of possible reasonable accommodations for Long COVID and other disabilities.
If you have any questions about my request you can contact me in writing or by phone. However, I would appreciate a written response to this request within two weeks of the date of this letter. Thank you very much.
Sincerely,
[Your name]
[Your full address]
[Your phone number]