OIEA Pregnancy Related Accommodation Notification Form

<!doctype html> <html class="no-js" lang="en"> <head> <meta charset="iso-8859-1"> <meta http-equiv="x-ua-compatible" content="ie=edge"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <link rel="apple-touch-icon-precomposed" sizes="152x152" href="images/apple-touch-icon-152x152-precomposed.png"> <link rel="apple-touch-icon-precomposed" sizes="144x144" href="images/apple-touch-icon-144x144-precomposed.png"> <link rel="apple-touch-icon-precomposed" sizes="120x120" href="images/apple-touch-icon-120x120-precomposed.png"> <link rel="apple-touch-icon-precomposed" sizes="114x114" href="images/apple-touch-icon-114x114-precomposed.png"> <link rel="apple-touch-icon-precomposed" sizes="76x76" href="images/apple-touch-icon-76x76-precomposed.png"> <link rel="apple-touch-icon-precomposed" sizes="72x72" href="images/apple-touch-icon-72x72-precomposed.png"> <link rel="apple-touch-icon-precomposed" href="images/apple-touch-icon-precomposed.png"> <title>OIEA Pregnancy Related Accommodation Notification Form</title> <meta http-equiv="content-type" content="text/html; charset=iso-8859-1"> <meta name="robots" content="noindex"> <link rel="stylesheet" type="text/css" href="publicside_assets/jquery_filer/css/jquery.filer.css"> <link rel="stylesheet" type="text/css" href="publicside_assets/jquery_filer/css/themes/jquery.filer-dragdropbox-theme.css"> <script src="https://use.typekit.net/feb7wgs.js"></script> <script>try{Typekit.load({ async: true });}catch(e){}</script> <link rel="stylesheet" href="publicside_assets/bower_components/reportingform_app.css"> <style type="text/css"> body { background-color: #00356b; } .sectionheader { color: #FFF; background: #00356b; } </style> </head> <body> <div id="wrapper" class="row">  <div class="small-12 columns">  <header> <div class="row" id="reportheader"> <div id="reportheader-left"> <p><img src="https://maxfs-useast-01.s3.amazonaws.com/yale/logos/YaleUniv_19.gif?response-cache-control=must-revalidate%2C%20post-check%3D0%2C%20pre-check%3D0&response-content-disposition=inline%3B%20filename%3D%22YaleUniv_19.gif%22&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAV47ECHXWF5MDWZZG%2F20250218%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Date=20250218T230319Z&X-Amz-SignedHeaders=host&X-Amz-Expires=7200&X-Amz-Signature=1c0a3dc6cf3959acf041c2ee5e386644cb0d0b5289c74048dc7633b3f83e88f9" alt="Yale University Logo"></p> </div> <div id="reportheader-right"> <h1>OIEA Pregnancy Related Accommodation Notification Form</h1><br> </div> </div> <div id="main_instructions" class="row"> <div class="large-12 columns"> <p><span style="font-size: 18pt;">*For Staff with Pregnancy-Related Accommodation Requests, please consult with <a href="https://your.yale.edu/work-yale/benefits/absence-management-and-accommodations-services">Absence Management and Accommodation Services</a>. </span></p> <p><span style="font-size: 18pt;">*For Students with Pregnancy-Related Accommodation Requests, please consult with the <a href="https://titleix.yale.edu">Title IX Office</a> or <a href="sas.yale.edu">Student Accessibility Services</a>.  </span> </p> <p><span style="font-size: 10pt;">The Office of Institutional Equity and Accessibility (OIEA) administers the accommodation program for faculty, psychiatric residents, and postdoctoral and posgraduate associates with limitations related to pregnancy, childbirth or related conditions.</span></p> <p><span style="font-size: 10pt;">Any staff members or applicants for employment who need a pregnancy-related accommodation should consult with Yale Human Resources' Absence Management and Accommodation Services unit. Yale also provides reasonable modifications to policies, practices and procedures for students who are pregnant or have a related medical condition. Any student who requires an accommodation due to a pregnancy or related medical condition should consult with Yale's <a href="https://titleix.yale.edu">Title IX Office</a> or <a href="https://sas.yale.edu">Student Accessibility Services</a>. </span></p> <p><span style="font-size: 10pt;">The purpose of this form is to notify OIEA of a request for an accommodation related to pregnancy, childbirth or a related medical condition. If you would like to learn more about the process or have any questions, please click here [TBD].</span></p> <p> </p> <p> </p> </div> </div> </header> <main> <form name="IR" id="IR" enctype="multipart/form-data" accept-charset="iso-8859-1" method="post" action="" data-abide novalidate> <input type="hidden" name="institution" id="institution" value="YaleUniv"> <input type="hidden" name="layout_id" value="19"> <input type="hidden" name="x_requestor_ip" value="8.222.208.146"> <input type="hidden" name="x_requestor_starttime" value="1739919799.0189"> <input type="hidden" name="x_requestor_token" value="d7c48a9c38ffd223a23e0f23e5b4dd71"> <input type="hidden" name="recaptcha_response" id="recaptcha_response"> <div data-abide-error class="alert callout" style="display: none;"> <p id="error_detail_top"></p> </div> <section> <h2 class="sectionheader">Entering your e-mail address ensures that you receive a copy of this form.</h2> <div id="section1"> <div class="column row"> <div class="sectioninstructions"></div> </div> <div class="row"> <div class="generallabel">   </div> <div class="generalinput"> <a href="https://cm.maxient.com/reportingform.php?YaleUniv&layout_id=19&promptforauth=true">Enable additional features by logging in.</a> </div> </div> <div class="row" style="display: none;"> <div class="generallabel"> <label for="reporters_full_name">Your full name:</label> </div> <div class="generalinput"> <input type="text" name="reporters_full_name" id="reporters_full_name" maxlength="80" value=""> </div> </div> <div class="row" style="display: none;"> <div class="generallabel"> <label for="reporters_title">Your position/title:</label> </div> <div class="generalinput"> <input type="text" name="reporters_title" id="reporters_title" maxlength="80" value=""> </div> </div> <div class="row" style="display: none;"> <div class="generallabel"> <label for="reporters_phone_number">Your phone number (preferred):</label> </div> <div class="smallerinput"> <input type="text" name="reporters_phone_number" id="reporters_phone_number" maxlength="20" value=""> </div> </div> <div class="row" > <div class="generallabel"> <label for="reporters_email_address">Your email address (preferred):</label> </div> <div class="generalinput"> <input type="email" name="reporters_email_address" id="reporters_email_address" maxlength="80" value=""> <span class="form-error">Email address must be of a valid format.</span> </div> </div> <div class="row" style="display: none;"> <div class="generallabel" > <label for="reporters_physical_address">Your physical address (Office):</label> </div> <div class="generalinput"> <input type="text" name="reporters_physical_address" id="reporters_physical_address" maxlength="80" value=""> </div> </div> <div class="row"> <div class="generalinput"> <input type="hidden" name="nature" id="nature" value="HIDE"> </div> </div> <div class="row"> <div class="generalinput"> <input type="hidden" name="urgency" id="urgency" value="HIDE"> </div> </div> <div class="row"> <div class="smallerinput"> <input type="hidden" name="date_of_incident" id="date_of_incident" value="2025-02-18"> </div> </div> <div class="row" style="display: none;"> <div class="generallabel"> <label for="time_of_incident" id="lbl_time_of_incident">Time of incident:</label> </div> <div class="smallerinput"> <input autocomplete="off" type="text" name="time_of_incident" id="time_of_incident" aria-labelledby="lbl_time_of_incident" maxlength="10" value=""> </div> </div> <div class="row"> <div class="generalinput"> <input type="hidden" name="location_of_incident" id="location_of_incident" value="HIDE"> </div> </div> <div class="row" style="display: none;"> <div class="generallabel"> <label for="location_of_incident_specific">Specific location:</label> </div> <div class="generalinput"> <input autocomplete="off" type="text" name="location_of_incident_specific" id="location_of_incident_specific" size="40" maxlength="100" value="" style="position:relative;"> </div> </div> </div> </section> <section> <h2 class="sectionheader">Requestor Information</h2> <div id="section3"> <div class="column row"> <div class="sectioninstructions"><p>Please provide the following information for the individual who requested an accommodation. </p></div> </div> <div id="involvedPersons"> <div class="personrow clonedInput" id="personrow0"> <fieldset> <legend class="show-for-sr legend_person">Involved party 1</legend> <div class="row small-up-1 medium-up-2 large-up-4"> <div class="column"> <label for="person_0" class="label_person">Name </label> <input autocomplete="off" type="text" name="person[]" id="person_0" class="input_person" maxlength="50" value=""> </div> <div class="column"> <label for="dob_0" class="label_dob">Position/Title</label> <input autocomplete="off" type="text" name="dob[]" id="dob_0" class="input_dob" maxlength="10" value=""> </div> <div class="column"> <label for="phone_0" class="label_phone">Phone number (preferred)</label> <input autocomplete="off" type="text" name="phone[]" id="phone_0" class="input_phone" maxlength="50" value=""> </div> <div class="column" > <label for="halladdress_0" class="label_halladdress">Net ID#</label> <input autocomplete="off" type="text" name="halladdress[]" id="halladdress_0" maxlength="50" class="input_halladdress" value="" data-lpignore data-1p-ignore> </div> </div> </fieldset> </div> </div> <input type="button" id="btnAdd" class="button" value="Add another party"> <input type="button" id="btnDel" class="button hide" value="Remove last party"> </div> </section> <section> <h2 class="sectionheader">Questions</h2> <div id="addquest"> <div class="sectioninstructions"><p>Help us learn more about the request. </p></div> <input type="hidden" name="numberOfAdditionalQuestions" value="3"> <div class="row"> <div class="small-12 columns question"> <label class="addquest_label" for="aq[1][answer]">Please provide a brief explanation of the nature of the request.<span class="required">(Required)</span></label> <input autocomplete="off" type="text" name="aq[1][answer]" id="aq[1][answer]" class="answers" required maxlength="100"> <span class="form-error addquest_error">This field is required.</span> </div> </div> <div class="row"> <div class="small-12 columns question"> <label class="addquest_label" for="aq[2][answer]">Please provide a brief explanation of the reason for a reasonable accommodation (if known).</label> <textarea autocomplete="off" spellcheck="true" name="aq[2][answer]" id="aq[2][answer]" class="answers" rows="5"></textarea> <span class="form-error addquest_error">This field is required.</span> </div> </div> <div class="row"> <div class="small-12 columns question"> </div> </div> </div> </section> <section> <h2 class="sectionheader">Supporting Documentation</h2> <div id="supportdocs"> <div class="column row"> <div class="sectioninstructions" id="uploadFilesInstructions"> <p> Please submit any documentation relevant to the requestor's request here (if available). 5GB maximum total size.<br><strong>Attachments require time to upload, so please be patient after submitting this form.</strong> </p> </div> </div> <div class="column row"> <input tabindex="-1" type="file" name="uploadedFiles[]" id="filer_input" aria-labelledby="uploadFilesInstructions" multiple="multiple"> </div> </div> </section> <section> <div class="row"> <div class="small-12 columns text-center" id="submit_btn"> <h2 class="show-for-sr sectionheader">Submission</h2> <p><input autocomplete="off" type="checkbox" id="sendCopyToAuthor" name="sendCopyToAuthor" value="Yes" ><label for="sendCopyToAuthor">Email me a copy of this report</label></p> <input autocomplete="off" class="large button" type="submit" name="submit" id="submit" value="Submit"> </div> </div> </section> <div class="row"> <div class="small-12 columns"> <div data-abide-error class="alert callout" style="display: none;"> <p id="error_detail_bottom"></p> </div> </div> </div> </form> </main> </div> </div> <script src="publicside_assets/bower_components/jquery/dist/jquery.js"></script> <script src="publicside_assets/bower_components/what-input/what-input.js"></script> <script src="publicside_assets/bower_components/foundation-sites/dist/foundation.min.js"></script> <script src="publicside_assets/bower_components/app.js"></script> <script src="https://cdn.jsdelivr.net/npm/timepicker@1.11.14/jquery.timepicker.min.js"></script> <script src="publicside_assets/cloneform/clone-form-td2.js"></script> <script src="publicside_assets/jquery_filer/js/jquery.filer.AHmods102620.min.js"></script> <script src="https://use.fontawesome.com/b22e7499d6.js"></script> <script type="text/javascript"> // add tabindex="0" and link icon from Font Awesome to help visually identify as a link any <a> elements, and so tabbing will work correctly on form var alinks = document.getElementsByTagName('a'); for (i=0; i<alinks.length; i++) { alinks[i].setAttribute("tabindex","0"); alinks[i].innerHTML += " <i 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Please review the highlighted fields.'; document.getElementById('error_detail_bottom').innerHTML = '<i class="fa fa-exclamation-triangle fa-2" aria-hidden="true"></i> ' + visibleErrors.length + ' fields have errors. Please review the highlighted fields.'; $('html, body').animate({ scrollTop: $(invalid_fields[0]).offset().top - 40 }, 1000, function() { $(invalid_fields[0]).focus(); /*for putting focus on the first invalid field*/ }); }); // 11/18/19: HTML5 input type=date detection var isDateSupported = function () { var input = document.createElement('input'); var value = 'a'; input.setAttribute('type', 'date'); input.setAttribute('value', value); return (input.value !== value); }; if (isDateSupported()) { $('#lbl_date_of_incident').append('<span class="show-for-sr">Format is MM/DD/YYYY.</span>'); } if (!isDateSupported()) { $('#lbl_date_of_incident').append('<br>Format is YYYY-MM-DD.'); } </script> </body> </html>

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OIEA Pregnancy Related Accommodation Notification Form