Disabilities Self-Identification

Disability Self-identification Survey

INFORMATION and INSTRUCTIONS

Pursuant to s. 230.04 (9r)(b), Wis. Stats., and OSER/DAA Bulletin AA-37, agencies have the responsibility to provide new and existing employees with the opportunity to self-identify as a person with a disability and to provide reasonable changes or accommodations within their work place. Therefore agencies are required to conduct a disability self-identification and needs assessment survey for all current employees every two years.

GENERAL INFORMATION:

This information is requested in order to evaluate equal employment opportunity/affirmative action efforts and to comply with state law only. It will not be used to discriminate in any way. Completion of Section B of the form is optional. The information will be confidential with the following exceptions:
• Supervisors and managers may be informed regarding necessary restrictions on the work or duties of the employee and necessary accommodations.
• Government officials investigating compliance with non-discrimination laws shall be provided with relevant information on request.

DEFINITIONS:

Person With A Disability
The Americans with Disabilities Act of 1990 (ADA) defines a person with a disability as a person who has a physical or mental impairment that substantially limits one or more of the major life activities, a record of such an impairment or is regarded as having such an impairment. Examples of major life activities are: hearing, seeing, speaking, breathing, performing manual tasks, walking, caring for oneself, learning, or working. [29 C.F.R. S1630.2(i)]

Person With A Severe Disability
Severely disabled employee means an employee with a chronic disability if the disability meets all of the following conditions:
a. It is attributable to a mental or physical impairment or combination of mental and physical impairments.
b. It is likely to continue indefinitely.
c. It results in substantial functional limitations in one or more of the following areas of major life activity: self-care; receptive and expressive language; learning; mobility; capacity for independent living; and economic self-sufficiency. [s.230.04 (9r)(a) 2., Stats.]

Reasonable Accommodations
A reasonable accommodation is the effort made to make adjustments for the impairment of an employee or applicant by structuring the job or work environment in a manner that will enable the person with the disability to perform essential functions of the job. Reasonable accommodations include, but are not limited to: making facilities accessible; adjusting work schedules; restructuring jobs; providing assisting devices or equipment; providing readers or interpreters; and modifying work sites.