An employer also does not have to eliminate an essential function of a job as a reasonable accommodation, tolerate performance that does not meet its standards, or excuse violations of conduct rules that are job-related and consistent with business necessity and that the employer applies consistently to all employees such as rules prohibiting violence, threatening behavior, theft, or destruction of property.

If more than one accommodation will be effective, the employee's preference should be given primary consideration, although the employer is not required to provide the employee's first choice of reasonable accommodation. If a requested accommodation is too difficult or expensive, an employer may choose to provide an easier or less costly accommodation as long as it is effective in meeting the employee's needs.

May an employer be required to provide more than one accommodation for the same employee with diabetes? The duty to provide a reasonable accommodation is an ongoing one.

Although some employees with diabetes may require only one reasonable accommodation, others may need more than one. For example, an employee with diabetes may require leave to attend a class on how to administer insulin injections and later may request a part-time or modified schedule to better control his glucose levels.

An employer must consider each request for a reasonable accommodation and determine whether it would be effective and whether providing it would pose an undue hardship. May an employer automatically deny a request for leave from someone with diabetes because the employee cannot specify an exact date of return?

Granting leave to an employee who is unable to provide a fixed date of return may be a reasonable accommodation. Although diabetes can be successfully treated, some individuals experience serious complications that may be unpredictable and do not permit exact timetables.

An employee requesting leave because of diabetes or resulting complications for example, a foot or toe amputation , therefore, may be able to provide only an approximate date of return e.

In such situations, or in situations in which a return date must be postponed because of unforeseen medical developments, employees should stay in regular communication with their employers to inform them of their progress and discuss the need for continued leave beyond what originally was granted.

The employer also has the right to require that the employee provide periodic updates on his condition and possible date of return. After receiving these updates, the employer may reevaluate whether continued leave constitutes an undue hardship.

When it comes to safety concerns, an employer should be careful not to act on the basis of myths, fears, or stereotypes about diabetes. Instead, the employer should evaluate each individual on her skills, knowledge, experience and how having diabetes affects her.

When may an employer refuse to hire, terminate, or temporarily restrict the duties of a person who has diabetes because of safety concerns? An employer only may exclude an individual with diabetes from a job for safety reasons when the individual poses a direct threat.

A "direct threat" is a significant risk of substantial harm to the individual or others that cannot be eliminated or reduced through reasonable accommodation. In making a direct threat assessment, the employer must evaluate the individual's present ability to safely perform the job.

The employer also must consider:. The harm must be serious and likely to occur, not remote or speculative. Finally, the employer must determine whether any reasonable accommodation for example, temporarily limiting an employee's duties, temporarily reassigning an employee, or placing an employee on leave would reduce or eliminate the risk.

May an employer require an employee who has had an insulin reaction at work to submit periodic notes from his doctor indicating that his diabetes is under control? Yes, but only if the employer has a reasonable belief that the employee will pose a direct threat if he does not regularly see his doctor.

In determining whether to require periodic documentation, the employer should consider the safety risks associated with the position the employee holds, the consequences of the employee's inability or impaired ability to perform his job, how long the employee has had diabetes, and how many insulin reactions the employee has had on the job.

Example The owner of a daycare center knows that one of her teachers has diabetes and that she once had an insulin reaction at work when she skipped lunch. When the owner sees the teacher eat a piece of cake at a child's birthday party, she becomes concerned that the teacher may have an insulin reaction.

Although many people believe that individuals with diabetes should never eat sugar or sweets, this is a myth. The owner, therefore, cannot require the teacher to submit periodic notes from her doctor indicating that her diabetes is under control because she does not have a reasonable belief, based on objective evidence, that the teacher will pose a direct threat to the safety of herself or others.

What should an employer do when another federal law prohibits it from hiring anyone who uses insulin? If a federal law prohibits an employer from hiring a person who uses insulin, the employer is not be liable under the ADA. The employer should be certain, however, that compliance with the law actually is required, not voluntary.

The employer also should be sure that the law does not contain any exceptions or waivers. For example, the Department of Transportation's Federal Motor Carrier Safety Administration FMCSA issues exemptions to certain individuals with diabetes who wish to drive commercial motor vehicles CMVs.

The ADA prohibits harassment, or offensive conduct, based on disability just as other federal laws prohibit harassment based on race, sex, color, national origin, religion, age, and genetic information. Offensive conduct may include, but is not limited to, offensive jokes, slurs, epithets or name calling, physical assaults or threats, intimidation, ridicule or mockery, insults or put-downs, offensive objects or pictures, and interference with work performance.

Although the law does not prohibit simple teasing, offhand comments, or isolated incidents that are not very serious, harassment is illegal when it is so frequent or severe that it creates a hostile or offensive work environment or when it results in an adverse employment decision such as the victim being fired or demoted.

Employers should make clear that they will not tolerate harassment based on disability or on any other basis. This can be done in a number of ways, such as through a written policy, employee handbooks, staff meetings, and periodic training. The employer should emphasize that harassment is prohibited and that employees should promptly report such conduct to a manager.

Finally, the employer should immediately conduct a thorough investigation of any report of harassment and take swift and appropriate corrective action.

For more information on the standards governing harassment under all of the EEO laws, see www. The ADA prohibits retaliation by an employer against someone who opposes discriminatory employment practices, files a charge of employment discrimination, or testifies or participates in any way in an investigation, proceeding, or litigation related to a charge of employment discrimination.

It is also unlawful for an employer to retaliate against someone for requesting a reasonable accommodation. Persons who believe that they have experienced retaliation may file a charge of retaliation as described below. Any person who believes that his or her employment rights have been violated on the basis of disability and wants to make a claim against an employer must file a charge of discrimination with the EEOC.

A third party may also file a charge on behalf of another person who believes he or she experienced discrimination.

For example, a family member, social worker, or other representative can file a charge on behalf of someone who is incapacitated because of diabetes.

The charge must be filed by mail or in person with the local EEOC office within days from the date of the alleged violation. The day filing deadline is extended to days if a state or local anti-discrimination agency has the authority to grant or seek relief as to the challenged unlawful employment practice.

The EEOC will send the parties a copy of the charge and may ask for responses and supporting information. Before formal investigation, the EEOC may select the charge for EEOC's mediation program. Both parties have to agree to mediation, which may prevent a time consuming investigation of the charge.

Participation in mediation is free, voluntary, and confidential. If mediation is unsuccessful, the EEOC investigates the charge to determine if there is "reasonable cause" to believe discrimination has occurred. If reasonable cause is found, the EEOC will then try to resolve the charge with the employer.

In some cases, where the charge cannot be resolved, the EEOC will file a court action. If the EEOC finds no discrimination, or if an attempt to resolve the charge fails and the EEOC decides not to file suit, it will issue a notice of a "right to sue," which gives the charging party 90 days to file a court action.

A charging party can also request a notice of a "right to sue" from the EEOC days after the charge was first filed with the Commission, and may then bring suit within 90 days after receiving the notice. For a detailed description of the process, you can visit our website at www.

If you are a federal employee or job applicant and you believe that a federal agency has discriminated against you, you have a right to file a complaint. Each agency is required to post information about how to contact the agency's EEO Office.

You can contact an EEO Counselor by calling the office responsible for the agency's EEO complaints program. Generally, you must contact the EEO Counselor within 45 days from the day the discrimination occurred.

In most cases the EEO Counselor will give you the choice of participating either in EEO counseling or in an alternative dispute resolution ADR program, such as a mediation program. If you do not settle the dispute during counseling or through ADR, you can file a formal discrimination complaint against the agency with the agency's EEO Office.

You must file within 15 days from the day you receive notice from your EEO Counselor about how to file. Once you have filed a formal complaint, the agency will review the complaint and decide whether or not the case should be dismissed for a procedural reason for example, your claim was filed too late.

If the agency doesn't dismiss the complaint, it will conduct an investigation. The agency has days from the day you filed your complaint to finish the investigation. When the investigation is finished, the agency will issue a notice giving you two choices: either request a hearing before an EEOC Administrative Judge or ask the agency to issue a decision as to whether the discrimination occurred.

The ADA prohibition on asking applicants about medical conditions at the pre-offer stage does not prevent federal contractors from complying with the OFCCP's regulation. See Letter from Peggy R. Mastroianni, EEOC Legal Counsel, to Patricia A. Shiu, Director of OFCCP, www.

htm bottom. A person experiencing hypoglycemia low blood sugar may feel weak, shaky, confused, or faint. Most people with diabetes, however, recognize these symptoms and will immediately drink or eat something sweet. Many individuals with diabetes also carry a blood glucose monitoring kit with them at all times and test their blood sugar levels as soon as they feel minor symptoms such as shaking or sweating.

Often, a person's blood sugar returns to normal within 15 minutes of eating or drinking something sweet. See generally information from the American Association of Diabetes, www. See "Concerns About Safety. Of course, an employer may call employees on extended leave to check on their progress or to express concern for their health without violating the ADA.

For a discussion of how employers should treat situations in which an employee may be covered both by the FMLA and the ADA, see Questions 21 and 23 in the EEOC Enforcement Guidance on Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act rev. See National Center for Biotechnology Information, U.

National Library of Medicine, www. For this reason employers may want to include a warning in the request for documentation that the employee or the employee's doctor should not provide genetic information.

at § Breadcrumb Home laws guidance Diabetes in the Workplace and the ADA. In particular, this document explains: when an employer may ask an applicant or employee questions about her diabetes and how it should treat voluntary disclosures; what types of reasonable accommodations employees with diabetes may need; how an employer should handle safety concerns about applicants and employees with diabetes; and how an employer can ensure that no employee is harassed because of diabetes or any other disability.

Job Applicants Before an Offer of Employment Is Made 1. This means that an employer cannot legally ask an applicant questions such as: whether she has diabetes or has been diagnosed with diabetes for example, gestational diabetes in the past; whether she uses insulin or other prescription drugs or has ever done so in the past; or, whether she ever has taken leave for medical treatment, or how much sick leave she has taken in the past year.

Of course, an employer may ask questions pertaining to the qualifications for, or performance of, the job, such as: whether the applicant has a commercial driver's license; or whether she can work rotating shifts.

The employer explains that cashiers typically get two minute breaks and 30 minutes for lunch during an eight-hour shift and asks whether she needs an accommodation for example, more frequent breaks or a longer lunch period.

Before an offer of employment is made, the employer may not ask any questions about the condition itself, such as how long the applicant has had diabetes, how much medication she takes, or whether anyone else in her family has diabetes. Example 2 : A qualified candidate for a police officer's position is required to have a medical exam after he has been extended a job offer.

During the exam, he reveals that he has had diabetes for five years. He also tells the doctor that since he started using an insulin pump two years ago, his blood sugar levels have been stable. The candidate also mentions that in his six years as a police officer for another department, he never had an incident related to his diabetes.

Because the candidate can perform the job's essential functions without posing a direct threat, it would be unlawful for the employer to withdraw the job offer. Employees The ADA strictly limits the circumstances under which an employer may ask questions about an employee's medical condition or require the employee to have a medical examination.

The supervisor overhears the receptionist tell a co-worker that she feels tired much of the time, is always thirsty, and constantly has to go to the bathroom.

The supervisor may ask the receptionist whether she has diabetes or send her for a medical examination because he has a reason to believe that diabetes may be affecting the receptionist's ability to perform one of her essential duties - sitting at the front desk for long periods of time.

Example 5 : A newspaper reporter, who has been on leave for two months because of complications stemming from her diabetes, notifies her employer that she will be able to return to work in two weeks but will need a flexible schedule.

Because the reporter's job frequently requires her to meet short deadlines, the employer may ask her to provide a doctor's note or other documentation indicating whether there are any limits on how many hours a day she can work.

In addition, an employer may ask an employee about his diabetes to the extent the information is necessary: to support the employee's request for a reasonable accommodation needed because of his diabetes; to verify the employee's use of sick leave related to his diabetes if the employer requires all employees to submit a doctor's note to justify their use of sick leave; 16 or to enable the employee to participate in a voluntary wellness program.

Under the following circumstances, however, an employer may disclose that an employee has diabetes: to supervisors and managers in order to provide a reasonable accommodation or to meet an employee's work restrictions; to first aid and safety personnel if an employee may need emergency treatment or require some other assistance because, for example, her blood sugar level is too low; to individuals investigating compliance with the ADA and similar state and local laws; and where needed for workers' compensation or insurance purposes for example, to process a claim.

Some employees may need one or more of the following accommodations: a private area to test their blood sugar levels or to administer insulin injections a place to rest until their blood sugar levels become normal breaks to eat or drink, take medication, or test blood sugar levels Example 6 : A manufacturing plant requires employees to work an eight-hour shift with just a one-hour break for lunch.

An employee with diabetes needs to eat several times a day to keep his blood sugar levels from dropping too low. Absent undue hardship, the employer could accommodate the employee by allowing him to take two minute breaks each day and letting him make up the time by coming to work 15 minutes earlier and staying 15 minutes later.

leave for treatment, recuperation, or training on managing diabetes 18 modified work schedule or shift change Example 7 : A nurse with diabetes rotated from working the a. to p. shift to the midnight to a. Her doctor wrote a note indicating that interferences in the nurse's sleep, eating routine, and schedule of insulin shots were making it difficult for her to manage her diabetes.

Her employer eliminated her midnight rotation. allowing a person with diabetic neuropathy 19 that makes it difficult to stand for long periods of time to use a stool reallocation or redistribution of marginal tasks to another employee Example 8 : A janitor, who had a leg amputated because of complications from diabetes, can perform all of his essential job functions without accommodation but has difficulty climbing into the attic to occasionally change the building's air filter.

If you have neuropathy, you might need permission to sit on a chair or stool. In plain English, they are changes that help people with disabilities compete for a wide range of jobs, excel in their work, and be treated fairly. Most people with diabetes only need minor changes that can be provided at little or no cost to their employers.

Your employer may have to change an otherwise valid workplace policy for you. You should not be denied a reasonable accommodation just because it goes against standard policies or because non-disabled employees are not entitled to it.

Common reasonable accommodations for individuals with diabetes What are reasonable accommodations? What accommodations do people with diabetes need?