AD290

In confidence when complete

Personal Supportive Passport

The individual who owns this document:

Name:

This passport is a collaborative document between the individual and Hampshire Constabulary. Hampshire Constabulary aim to support all staff and officers to remain gainfully employed, by considering all workplace reasonable adjustments that could enable this to happen.

Hampshire Constabulary recognises that officers and staff members may need them to make some adjustments to work practices and work equipment in order to ensure that, so far as is reasonably practicable, they have the same opportunities to progress and be successful throughout their career at Hampshire Constabulary. This may occur as a result of a long term visible or non-visible disability.

What is a Personal Supportive Passport for?

The passport is a means by which you can work with your line manager to identify the most effective way of managing your physical and/or mental health and well-being within the context of the work environment. This passport is tailored to your needs and focuses on how your condition impacts on you and the type of support you need to help you manage it effectively whilst you are at work.

The passport will move with you throughout your career with Hampshire Constabulary and be subject to regular review between you and your line manager to ensure that any adjustments made continue to meet both your needs and those of Hampshire Constabulary.

The passport is split into four sections; these are:

  1. The nature of your disability, injury or health condition
  2. Organisational/external referrals for medical/workplace advice
  3. The adjustments considered/implemented to assist you in your role
  4. Reviews and updates

Before completing this document, please ensure you are fully aware of Hampshire Constabulary’s Guidance on Workplace Adjustments.

Section 1: The nature of my condition

To be completed by you and your line manager.

NB: Support in the completion of this document can also be obtained from Occupational Health, Health & Safety, Dyslexia Action Group Assessors, Equality & Inclusion, HR and the Disability Support Network etc.

Date of meeting:
Names of attendees and in what capacity they are attending the meeting:
Your job title and key duties:

Suggested questions (please feel free to add any additional questions that are relevant to your personal situation):

The nature of my condition is:
The pattern of my condition is (stable, relapsing/remitting, recurrent etc):
This affects me…(such as physically, emotionally and/or behaviourally)
Side effects of my medication and/or treatment are:
Signs that my condition is deteriorating are:
First aid measures my line manager needs to be aware of in relation to my condition (egepipen, glucose gel):
The adjustments/coping strategies I have at work currently are:
The difficulties I require adjustments for are (please list):
If none, please go to Section 2.

Section 2: Referral for medical/workplace advice

In conjunction with your line manager, please discuss to see if there is a requirement for you to be referred to Occupational Health, Dyslexia Assessor Group, Learning and Development or Health and Safety (DSE).

Is there a requirement for a referral?

If ‘yes’ please complete the below:

Referred to:
Why referred:
Date referral made:

Section 3: The adjustments considered/identified

Below to be discussed and completed by line manager. Following this, an AD294 Reasonable Adjustment Recording form needs to be completed which will include all agreed reasonable adjustments.

Adjustments identified: / Considered reasonable? / Action required: / Date implemented:
1 / <select>YesNo
2 / <select>YesNo
3 / <select>YesNo
4 / <select>YesNo
5 / <select>YesNo
6 / <select>YesNo
If any of the above adjustments identified were considered unreasonable, please provide rationale for this decision:

Notes:

  1. It is your responsibility to advise a new line manager of your passport as this is your document to share.
  2. If you require any reasonable adjustments for training courses, recruitment activities etc. then it is your responsibility to make training/recruitment aware before the course or activity.
  3. It is your responsibility to inform your line manager of any changes or updates agreed between yourselves.
  4. It is the responsibility of your line manager to agree (according to reasonableness), order and implement your reasonable adjustments.
  5. Your line manager should retain a copy of this passport because they are accountable for implementation and review.

Personal Adjustment Passport Sign off

I agree that this is an accurate reflection of the meeting and give consent for a copy to be held by my line manager:

Staff member: / Signature: / Date:
Line manager: / Signature: / Date:

This is a confidential document which will not be stored on your personal file. However, it may in certain circumstances be subject to disclosure e.g. an employment tribunal.

Permission will always be sought from yourself before content is shared by your line manager.

Section 4: Review update of reasonable adjustments

It is recommended that a review of your reasonable adjustments take place on a regular basis to ensure that they continue to meet your needs. Minimum review should be one year.

1st Review – Date:
Are the adjustments still effective? If not please provide details of any changes identified and agreed.
Line manager:
Staff member:
2ndReview – Date:
Are the adjustments still effective? If not please provide details of any changes identified and agreed.
Line manager:
Staff member:
3rdReview – Date:
Are the adjustments still effective? If not please provide details of any changes identified and agreed.
Line manager:
Staff member:
4thReview – Date:
Are the adjustments still effective? If not please provide details of any changes identified and agreed.
Line manager:
Staff member:

Whenever a review has taken place, it is the line manager’s responsibility to update the passport and the AD294 Reasonable Adjustment Request Form.