Workplace Equipment Adaptation Grant Application Form: Section 2

• Published date: 10 May 2021
• Issuer: Department of Social Protection

Amended: 19/11/2018 (Final version)

REASONABLE ACCOMMODATION FUND

FOR THE EMPLOYMENT OF PEOPLE WITH A DISABILITY

Section 2 - Grant Application

Workplace Equipment/Adaptation Grant Scheme

Application details

Application by:

Employer/Company Employee/Job Applicant Self-employed

The Grant is to be used for (tick all that are applicable):

Adaptation of Premises Retention of Employment

Adaptive Equipment New Employment

Upgrading of Equipment Self–Employment

Training in use of Equipment

Description of Equipment/Adaptation and Justification (use a separate page if necessary and

attach medical evidence that the equipment/adaptation is needed due to the nature of the disability):

______________________________________________________________________________

______________________________________________________________________________

Amount requested excluding VAT: €____________________________________

Signed: ____________________________________ Date: _____/______/______

Notes:

1. Application to be accompanied by: 1 quotation if the total cost excluding VAT is under €700, 2 quotations

if the total cost excluding VAT is over €700 and under €1,500, OR 3 quotations if the total cost

excluding VAT is over €1,500.

VAT must be itemised separately in each quotation.

2. Plans should accompany workplace adaptation proposals and a timescale for completing the work should

be indicated.

Adaptations to premises should comply with Building Regulations and recommendations set out in

Technical Guidance Document M Access for People with Disabilities (see

www.environ.ie/en/DevelopmentHousing/BuildingStandards/PartMDocuments/).