WORKPLACE ADJUSTMENT PLAN

Employee / role: [Name and role]
Conversation date: [Date]
Employee contact preference: [Method]
Manager / coordinator: [Name]

1. Work-related barrier
[Describe the task, environment or process and its practical impact.]

2. Adjustment to try
[Describe the agreed support. If still proposed, mark it as proposed.]

3. Implementation
Owner: [Person responsible]
Target start date: [Date]
Resources or approval needed: [Details]
Interim support while waiting: [Details]

4. Review
Review date: [Date agreed together]
What would improvement look like? [Practical indicators]
Employee feedback: [To complete at review]
Manager feedback: [To complete at review]
Next step: [Continue / change / discuss alternatives]

5. Sharing and continuity
Who needs this information and why? [Names or roles]
What information should be shared? [Minimum necessary]
Where will the agreed record be kept? [Location]
Who updates it if role, manager or needs change? [Name / role]

Employee and manager confirmation of the record: [Names / date]
Outstanding issues or different views: [Details]