Special Dietary Needs Accommodation Form

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The Special Dietary Needs Accommodation Form is a document that provides information about an individual's dietary restrictions and requirements. This form is typically used to inform event organizers, venues, or institutions about specific dietary needs such as vegetarian, gluten-free, dairy-free, vegan, or other food allergies and intolerances. The form usually includes details about the types of foods that can be consumed, any potential allergens or triggers, and instructions for preparing or procuring suitable meals.

Implementing a Special Dietary Needs Accommodation Form benefits your organization in several ways:

• Reduces risk of allergy-related incidents
• Enhances employee and customer satisfaction
• Improves company culture by promoting inclusivity and consideration for diverse needs
• Helps maintain a healthy and safe work environment
• Supports compliance with relevant laws and regulations, such as the Americans with Disabilities Act (ADA)
• Facilitates effective communication and accommodation of employees' dietary requirements

1. Name and Date
2. Physician's Statement (signed by a licensed medical doctor)
3. Type of Dietary Need or Condition (e.g., food allergy, gluten intolerance, etc.)
4. Description of the Accommodation Requested (e.g., meal modifications, separate dining area, etc.)
5. List of Required Foods/Ingredients to be Avoided