Protected B when completed
Government of Canada (GC) Workplace Accessibility Passport
Également disponible en français
Go to page 4 to begin completing or updating the form
Accessibility Statement
The Government of Canada Workplace Accessibility Passport follows accessibility guidelines for Microsoft Word documents and every effort has been made to ensure it is accessible. You can change the layout and font of Microsoft Word documents to meet your specific accessibility needs. Visit Accessibility tools for Word - Microsoft Support to learn more. 
If you encounter accessibility barriers using this document, please email: AccessibilityPassport.Passeportdaccessibilite@tbs-sct.gc.ca
What is it?
•	The Government of Canada (GC) Workplace Accessibility Passport is a tool for public service employees to document the barriers they may face at work and the adaptive tools and support measures they need to succeed (refer to the Definitions section).
•	Managers are responsible for ensuring each employee has the tools and support measures they need, including any adaptive tool or measure. 

About this form
•	Use of the GC Workplace Accessibility Passport is voluntary for employees.
•	Once completed, the information is confidential and belongs to the employee, who should decide when and with whom to share it. 
•	Employees who would benefit from workplace adjustments or modifications are encouraged to use the Passport, as they are responsible for informing their manager of any workplace accommodation needs.
•	Employees are not required to self-declare in order to use the Passport.
•	The Passport should be reviewed at least every 6 months. 
•	Detailed instructions, definitions and examples of tools, services and/or support measures can be found in the Additional Passport Instructions section below. Additional resources and guidance are available on the GC Accessibility Hub.
•	The Passport can be used to open a dialogue with your manager and document workplace accommodation requirements and decisions when:
o	You apply for a new position; You have a new manager
o	You start in a new job; You consider language training or any other learning programs
o	Other changes in circumstance which may require a workplace accommodation
•	If you are a student, casual, or term employee, you may be able to access Shared Services Canada’s Lending Library Service – contact the Accessibility, Accommodation and Adaptive Computer Technology program (email: ssc.aaact-aatia.spc@canada.ca) 
How do I use it?
Employee
1.	Fill out the Passport by identifying barriers and solutions to address these barriers. Refer to Additional Passport Instructions for information on completing the Passport.
2.	Send the GC Workplace Accessibility Passport to your manager, to start or continue the discussion about accessibility supports you need to do your job. For more information visit the Employees’ Conversation Guide on the Passport GC Pedia Page.
o	If you have questions about the best workplace accommodation tools or support measures, consult your organization’s Corporate Services Professionals / Accessibility Advisors or the Accessibility, Accommodation and Adaptive Computer Technology Program Team (email: ssc.aaact-aatia.spc@canada.ca)
3.	Update the Passport when your workplace accommodation requirements change, or when you change managers – even if temporarily 
4.	Protect the privacy of the information contained in your completed Passport, by saving it as Protected B (refer to Additional Passport Instructions on protecting privacy). 

Managers
1.	Create an inclusive workplace by asking each of your employees “how can I best support you to be successful in your job?” 
2.	Have open conversations about workplace accommodation needs and promote the GC Workplace Accessibility Passport as a mechanism to facilitate these conversations
3.	Use their completed Passport with employees to ensure workplace accommodation requests have been implemented and continue to be useful
4.	Protect the confidentiality of the information contained in each employee Passport
For more information visit the Managers’ Conversation Guide on the Passport GC Pedia Page.

Corporate Services Professionals / Accessibility Advisors 
1.	Support managers and employees with information and ensure they have access to expert advice regarding workplace accommodations
2.	Facilitate the procurement and delivery of adaptive tools and services.

Privacy Notice Statement
The completion and use of the GC Workplace Accessibility Passport form is voluntary. Sharing the form with others in your organization is also voluntary. Failing to provide relevant information may lead to a delay in your accommodation process. When you share your Passport information with your manager and other professionals, any personal information is collected by your organization under the authority of sections 7 and 11.1 of the Financial Administration Act, for the purpose of supporting a request for workplace accommodations. Any personal information collected will be protected, used and disclosed in accordance with the Privacy Act and as described in the Standard Personal Information Bank PSE 907 (Occupational Health and Safety), PSE 901 (Personnel Employee Record) as well as PSE 916 (Employee Assistance). Please note that anonymized and/or aggregated information about employees’ participation in the GC Workplace Accessibility Passport initiative may be used and disclosed to the Treasury Board of Canada Secretariat for program evaluation.
Under the Privacy Act, individuals have the right to request access to, and correction of, their personal information. Any questions about this Privacy Notice Statement may be directed to your organization’s Privacy Coordinator. If you are not satisfied with the response to your privacy concern, you may wish to communicate with the Office of the Privacy Commissioner.
Privacy Notice Statement – Canada Revenue Agency
Personal information is collected under the authority of paragraphs 30(1)(d) and 51(1)(i) of the Canada Revenue Agency (CRA) Act. Your information will be used to for the monitoring and reporting of accommodation cases within the CRA, and where applicable, to support the effective management of cases related to an injury, illness, medical condition, or disability. Information may also be shared or verified within the CRA for purposes of facilitating the accommodation process, collecting statistical information and conducting program evaluation. For cases related to an injury, illness, medical condition, or disability, the information may also be shared outside of the CRA with the health assessment services contractor as well as with employees’ personal physicians or medical practitioners for the purposes of determining employee’s medical limitations and restrictions, to the extent authorized by law. Failure or refusal to provide complete or accurate information may result in the CRA being unable to effectively manage the accommodation case.
Refer to Personal Information Bank Occupational Health and Safety PSE 907 at canada.ca/cra-info-source. Under the Privacy Act, individuals have a right of protection, access to and correction or notation of their personal information and to file a complaint with the Privacy Commissioner of Canada regarding our handling of their information.

GC Workplace Accessibility Passport
(Protected B when completed)
Section 1 – General Employee Information
An asterisk (*) marks the beginning of each response area
Name: *
Email Address: *
Telephone Number: *
Department or agency: * 
PRI: *  
Current Manager’s Information
Name: *
Email Address: *
Telephone Number: *
Section 2 – Barriers and Solutions
In this section, describe the barriers you face at work and the solutions you need. (Refer to Additional Passport Instructions for guidance, key terms and examples.)

Barrier: What specific barriers do you face in your current work situation?
*
Solution: What solutions would enable you or make it easier for you to do your job? (Refer to the Examples section for a list of potential solutions)
*
Have your workplace accommodation needs been previously assessed? If yes, what were the recommended adaptive tools or measures? 
*
Were any solutions (adaptive tools or support measures) provided by a previous manager? 
Indicate yes or no. If yes: 
When? *

Provide contact information for the previous manager (if you consent to your present manager contacting your previous manager(s) for guidance on how best to support you): 
* 
What additional supports by managers or colleagues, would enable your success in the workplace?
*
Section 3 – Additional Information
List, attach or summarize any documentation you want to provide your manager. You are not required to include any medical documentation. No information will be shared without your permission (refer to Section 3 in Additional Passport Instructions for the type of documentation).
*
Section 4 – GC Workplace Accessibility Passport Agreement
Record a list of the adaptive tools (e.g., screen reader; printer), services (e.g., personal assistant), or measures (e.g., summary notes from meetings shared with team members; task prioritization) your manager has agreed to provide.
* 
Date of agreement:
* 
Employee signature or typed name:
* 
Manager signature or typed name: 
* 
Section 5 – GC Workplace Accessibility Passport Review and Amendments
The information contained in the Passport must be reviewed at least every 6 months or when the employee changes position, manager or organization. 

Date of Implementation of all agreed upon measures listed in Section 4:
*
If, applicable, has all required training been completed? (If not, what is the anticipated date of completion?)
*
Review date (within 6 months of date of agreement): 
* 
Amendments: 
* 
Reason for amendments: 
* 
Comments: 
* 
Employee signature or typed name: 
* 
Manager signature or typed name: 
* 

Additional Passport Instructions
A.	Completing the Passport

Section 1 – General Employee Information
This section includes employee and current manager’s name and contact information.

Section 2 – Barriers and Solutions
The purpose of this section is to explain to your manager how you interact with the environment and the specific barriers you may face in doing your job. You are not required to disclose any medical or health-related information
Briefly describe the barriers you have faced and any solutions (adaptive tools or support measures) that might help you to succeed in the workplace. 
•	If you know the adaptive tools or support measures that will help you succeed in your job, describe them in this section. If not, discuss with your manager how to go about having your workplace accommodation needs assessed
•	Briefly describe any adaptive tools or support measures you have used in a previous job
•	Provide contact information for the previous manager, if applicable
•	Outline any additional support you would need from your manager or colleagues
•	Only answer the questions applicable to you
Section 3 – Additional Information
In this section, list, summarize or attach any documentation you may have to support your workplace accommodation request, such as: 
•	Prior formal or informal assessments or recommendations, with respect to workplace accommodations
•	Any adaptive devices, supports or other measures that are already in place
•	Any requirements in case of emergency or with respect to emergency evacuation
Section 4 – Workplace Accommodation Agreement
This section should be completed jointly by the employee and their manager. Its purpose is to record the results of conversations and, if necessary, any assessment of the employee’s workplace accommodation needs. 
•	It should clearly list and briefly describe the adaptive tools or support measures that will be provided to the employee. 
•	Both the employee and the manager must sign and date the Passport in this section
Section 5 – Passport Amendments
The information contained in the Passport must be reviewed at least every 6 months or when the employee changes position, manager or organization. Complete this section:
•	At least every 6 months to update the agreement, whether or not any changes are required to the workplace accommodation
•	When a change in the job or the employee’s situation require amendments to the type or nature of workplace accommodation to be provided
•	Add rather than replace information in this section and clearly indicate the date each update was made, in order to preserve a history of the workplace accommodations obtained
Protect the Privacy of the Information: 
Once you have completed the Passport, remember to save it as Protected B. You can store the document on your personal computer or use a secure electronic storage. You may wish to add a password to protect it by using Microsoft word features:
•	Go to File > Info > Protect Document > Encrypt with Password.
•	Type a password, then type it again to confirm it.
•	Select a password you will easily remember or find a secure method to write it down.    
•	Save the file to make sure the password takes effect.
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B.	Definitions
Barrier: 
A barrier means anything that would hinder the employee from achieving their full participation in the work environment. For the purposes of completing the Passport, a barrier can be work or task specific. It can refer to how the employee interacts with their work environment. A barrier does not need to refer to a specific disability or health condition.
Solution: 
The solution refers to the tools, support measures and any other accommodation or adjustment that is provided to address the barriers so the employee can fully participate in the workplace and succeed. 
Adaptive tool or equipment: 
These terms refer to software or equipment design to adapt or adjust the way in which regular workplace equipment or facilities are used, such as a screen magnifier, a screen reader, various types of assistive devices and software, a printer that an employee needs to replace a computer screen.
Support Measure: 
A measure can include modified work schedules; flexible work hours; meeting planning templates; team members sharing meeting notes; prioritizing deliverables; reorganizing work among team members; and other measures that address barriers.
Service: 
A service can include Sign Language interpretation, Communication Access Realtime Translation (CART) or a personal assistant to enable full participation in the workplace.
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C.	Examples of Tools, Services and/or Support Measures
This list of examples helps illustrate the broad range of mainstream and adaptive products and services that can improve participation of individuals with disabilities as well as all individuals in the federal public service. The following list of examples is not comprehensive. 
Tools and Equipment:
•	Ergonomic chair
•	Computer or tablet equipped with adaptive software to ensure full understanding, perception, or operation of the computer
•	Adaptive software, including any training or support needed to use the software
•	Monitor(s) of various sizes, monitor stands, monitor risers
•	Braille display or Braille printer 
•	Ergonomic keyboard or mouse, headphones, or switches
•	Adjustable work surface, such as sit-stand desk or desk riser
•	Appropriate workstation size, location such as assigned seating, quiet space, wide enough for wheelchair access or to accommodate a guide or service dog 
•	Angled writing surfaces and document holders/supports
•	Office supplies such as desktop or specific printer, coloured pens, various grip and or size pens, coloured paper, overlays, privacy filters, keyboard tray, and/or footrest
•	Adjusted lighting such as natural light, additional lighting, de-lamping and/or dimmable lights
Services and Support Measures:
•	Appropriate supports such as signage for allergies, and education for colleagues
•	CART services or Sign language interpretation
•	Written checklists or instructions 
•	Flexible work hours, as outlined in relevant terms and conditions of employment
•	Planning for uninterrupted work time, which could include a quiet space, scheduling time, or working from a remote location
•	Longer or more frequent breaks or stretch periods
•	Flexibility regarding work location, such as the employee’s place of residence, the regular workplace, an alternative location, or GC Co-working location.
•	For those working shift work, on call or other non-standard work week schedules, access to shift changes, or modified work hours
Non-Office Work Environment:
For those employees who do not work in an office environment, accommodation measures can include:
•	Appropriately sized bed in their sleeping quarters
•	Allergy-free meals and food options
•	Access to washrooms, regardless of group and level
•	Ergonomic tools, including supports for lifting heavy items
•	Braille text on specialized equipment
•	Uncluttered laboratory surfaces and shelving at appropriate height
•	Appropriate personal protective equipment (PPE)
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