Mental health reasonable adjustment confirmation template

Template for an employer to confirm an employee's reasonable adjustments for mental health after they've been agreed. Free to use.

You can copy and paste the template text into an email or document.


[Today's date]

Dear [name of employee],

I am writing to confirm your reasonable adjustment request.

We met to discuss your request for reasonable adjustments on [date].

[Give a summary of the meeting and the request. Include the specific concerns about work and the adjustments discussed].

We have agreed to put in place the following reasonable adjustments to support your mental health [give specific details of the adjustment and the expected outcome].

It's hoped that these adjustments will help you to manage your mental health and meet the needs of [name of organisation].

We have agreed to review the adjustments in [time period] to see how the adjustments are working for you and for [name of organisation].

We have agreed that this review will take place [give details on how, for example face to face with a line manager or by email].

If at any point before the agreed review you or [name of organisation] need to raise a concern about the adjustment or propose changes, we agreed that we will do this by [give details on how this will be raised, for example face to face with a line manager or by email].

Yours sincerely,

[Signature and full name of manager / employer]

Download this template

If you need the template in a different format, email

Last reviewed