Job Accommodation Network

Introduction: Terminology

This terminology is taken in part or in whole from the Epilepsy Foundation at http://www.efa.org and the National Society for Epilepsy http://www.epilepsynse.org.uk/pages/index/home/.

Generalized tonic clonic seizures, also called grand mal seizures, look like a sudden cry or fall; the individual may lose consciousness. The individual will exhibit rigidity, followed by muscle jerks, shallow or temporarily suspended breathing, bluish skin, and possible loss of bladder control. This seizure may last a couple of minutes. The individual may experience some confusion and/or fatigue, followed by a return to full consciousness.

Generalized absence seizures or petit mal seizures look like a blank stare, beginning and ending abruptly, lasting only a few seconds. Other behaviors exhibited may include rapid blinking or some chewing movements of the mouth.

Complex partial seizures, also called psychomotor seizures or temporal lobe seizures, usually start with a blank stare, followed by chewing, then followed by random activity. The individual appears unaware of surroundings, may seem dazed, and may mumble. The individual may be unresponsive, and clumsy. The individual may pick at clothing or try to remove clothes, and may run or appear afraid. The individual may struggle or resist restraint. This seizure lasts a few minutes, but post-seizure confusion can last longer. The individual has no memory of what happened during the seizure.

Simple partial seizures begin with involuntary jerking movement in the arm, leg, or face. The jerking may spread to become a convulsive seizure. The individual remains awake and aware throughout this type of seizure. The individual may see or hear things that are not there, and may feel unexplained sadness, anger, fear, or joy. The individual may also experience nausea, identify odd smells, or have a "funny" feeling in the stomach.

Atonic seizures, also known as drop attacks, occur when an individual suddenly drops and falls. This type of seizure generally lasts between 10 seconds and one minute. The individual will regain consciousness and can eventually stand and walk again.

Myoclonic seizures are sudden, brief, but massive muscle jerks that may involve the whole body or parts of the body. This type of seizure activity may cause an individual to spill what he/she is holding, or fall from a chair.

Photosensitivity epilepsy seizures can occur when an individual views or is exposed to, flashing or flickering lights or moving geometric shapes or patterns. Some triggers include watching television, playing video games, using a computer, and viewing strobe lights. Other natural occurrences of flashing or flickering lights include sunlight coming through a line of trees, looking out of a window, or sunlight reflecting on water.

Employees with Epilepsy: Questions and Answers

The following employment-related questions are typical epilepsy accommodation questions received at JAN's national toll-free hotline. A JAN consultant who specializes in cognitive and neurological disorders, and who is familiar with the Americans with Disabilities Act (ADA) and other disability legislation, crafted the responses. These responses are not guidance from the Equal Employment Opportunity Commission (EEOC) and are not intended to be legal advice.

For more information on the ADA and employment, read the EEOC's Title I Technical Assistance Manual online at http://www.jan.wvu.edu/links/ADAtam1.html.

Can people with epilepsy drive a truck, a school bus, a car, a forklift, etc.?

Yes, people with epilepsy can drive if they have a valid license for the vehicle they intend to operate on the job, or in their private life. Each state has its own requirements for restricting licenses of people whose seizures are uncontrolled, or whom have experienced recent seizure activity. However, most states do not restrict licenses of people whose seizures are controlled.

Can people with epilepsy work with small children, in jobs such as babysitter, teacher, day-care worker, etc?

Yes, people with epilepsy can perform a variety of jobs, including working with small children, assuming they have the experience and/or credentials to make them qualified for such positions, and do not pose a direct threat to themselves or others.

Can people with epilepsy work in retail jobs, or in the customer service or food service industry?

Yes, people with epilepsy can perform a variety of jobs, including working retail, customer services, or food service jobs. Many positions in retail, customer service, or food services are entry level positions requiring no prior job experience, and are often a first job for most people, including people with epilepsy.

Can people with epilepsy work as police officers?

Yes, people with epilepsy can be police officers or work in law enforcement, assuming they have the experience, training, and/or credentials to make them qualified for such position, and do not pose a direct threat to themselves or others. It is a myth that people with epilepsy are restricted from broad classifications of jobs (such as safety-sensitive jobs).

What liability does an employer have to an employee with epilepsy?

Under private or commercial health insurance plans, and under state worker's compensation regulations, an employer has the same liability to an employee with epilepsy as it has to any employee.

Are employees (or applicants) with epilepsy required to disclose their disability to their employer?

No. Employees need only disclose their disability if/when they need an accommodation to perform the essential functions of the job. Applicants never have to disclose a disability on a job application, or in the job interview, unless they need an accommodation to assist them in the application or interview process.

How does an employee with epilepsy ask for an accommodation?

An employee with epilepsy can ask for an accommodation at any time when he/she needs an accommodation to perform the essential functions of the job. The employee can make a request verbally or in writing, and is responsible for providing documentation of a disability.

Can an employer ask an employee with epilepsy to submit to a medical examination?

Yes, if the need for the medical examination is job-related and consistent with business necessity. Typically, employers will ask an employee with epilepsy to submit to a medical examination (also called a fitness-for-duty exam) after the employee had a seizure on the job, to determine if the employee can safely return to work, and if any accommodations will be needed on the job.

Special note: pre-job offer medical examinations or inquiries are illegal under the Americans with Disabilities Act. People with epilepsy (or any disability) do not have to submit to a medical exam, or answer any medical questions until after they have been conditionally offered a job.

Do employees with epilepsy pose a direct threat to themselves or others?

People who have seizures do not necessarily pose a direct threat to themselves or others. Employees who control their seizures through medication, or employees who are currently seizure-free, probably pose no current risk. Employees who have breakthrough seizures, or who have seizures on the job, may not pose a direct threat to themselves or others, depending on the nature and severity of the seizures. Even if direct threat exists, employers should consider whether the threat can be reduced or eliminated by providing an accommodation.

Can an employer discipline an employee with epilepsy who violates conduct or performance standards?

Yes, an employer can discipline an employee with epilepsy who violates conduct standards or fails to meet performance standards, even if the behavior being exhibited is caused by the employee's disability. However, an employer is obligated to consider reasonable accommodations that will help the employee with epilepsy meet the conduct or performance standards.

Plan of Action: Writing It, Using It, Working with It

Many employees with epilepsy do not need any type of accommodation on the job simply because their seizures are controlled (by medications, etc). It is not likely that an employee with controlled seizures will have a seizure on the job. However, in the unlikely event that a seizure does occur, it is wise to be prepared. Preparation begins with a plan of action.

Remember elementary school? Remember practicing for a fire drill? Everyone in the entire school knew the plan. Everyone, including teachers, students, cafeteria workers, and secretaries were prepared for the fire drill. We knew who was in charge, what responsibilities we had, how fast we had to respond to the alarm, how to get out of the building, and who to go to for help. That type of preparedness is what made the fire drill work efficiently. That is what made the fire drill safe.

A plan of action is very similar to an elementary school fire drill.

A plan of action is an emergency preparedness tool. It can be used to prepare for, or respond to, emergency situations that arise when a person has a seizure on the job.

A plan of action can be created with the employee and employer and can include information such as:

emergency contact information
visual or audible warning signs
how/when to provide on-site medical assistance
how/when to call 9-1-1
how to provide environmental support
who to designate as emergency responders
who to go to for help
how to educate co-workers about epilepsy

A properly implemented plan of action may reduce the confusion, panic, or fear that co-workers or customers experience if they see an employee having a seizure on the job. When the plan of action is "in action," one designated person calls a spouse or emergency contact. One designated person watches over the employee. No one provides incorrect or unnecessary medical assistance (CPR, for example). No one overreacts to the emergency because everyone is prepared for it, can identify it, and respond appropriately to it.

A sample plan of action is provided. Please use it as guidance on how to write a plan of action. Employers are not required by the ADA to use the following form, nor are employees with epilepsy required to create a plan of action if they do not want such a plan implemented in the workplace.

Accommodation Ideas for People with Epilepsy

Note: People with epilepsy may experience limitations in cognitive abilities, motor abilities, and sensory abilities that can affect workplace performance. People who have epilepsy may have some of these limitations and possibly all of these limitations. The degree of limitation will vary from individual to individual, and therefore, the accommodation provided will also vary.

Limitations in Cognitive/Neurological Abilities

Memory: Depending on the type of seizure activity, employees who had a seizure may have difficulty remembering tasks, events, or other details in the workplace.

Provide written information to employee
Post written information in a central location
Use a wall calendar
Use a daily or weekly task list
Provide verbal prompts or reminders
Use electronic organizer on computer or hand-held device
Tell employee what activities were taking place at time of seizure (you were on the phone, in a meeting, working on project, etc.)

Disorientation/Disorganization: Depending on the type of seizure activity, employees who had a seizure may be temporarily disoriented or disorganized at work.

Put employee's name plate on desk and/or door
Provide building directory or employee directory by name, floor, unit, etc.
Label items at desk (in-box, this week's videos, etc.)
Use nametags (or other identification) for all employees
Have auto-dial programmed on phone that connects to supervisor or other frequently used numbers

Time Management/Performing or Completing Tasks: Depending on the type of seizure activity, employees who had a seizure may temporarily be unable to complete tasks, perform tasks, or meet timelines.

Provide verbal prompts or reminders
Provide written or symbolic reminders
Use alarm watch or beeper
Avoid isolated workstations
Work in teams of two or more
Use clear timeframes or deadlines
Make daily/weekly task list

Using Office Equipment

Telephone: Depending on the type of seizure activity, employees who had a seizure may not remember how to use a telephone in the work environment.

Use large-button phone
Use phone with universal symbols (fire, police, doctor)
Use phone that is clearly labeled
Use headset instead of handset for simplicity purposes
Post directions on how to use phone
Provide list of names/extension numbers
Write down access codes, long distance account number, etc.

Copier or Fax: Depending on the type of seizure activity, employees who had a seizure may not remember how to use a fax or copy machine in the work environment.

Post directions
Use pictures illustrating directions
Identify contact person to answer questions (example: secretary)
Provide Telephone Identification Number (pass codes)
Write down passwords/access codes

Computer: Depending on the type of seizure activity, employees who had a seizure many not remember how to use a computer in the work environment.

Post who to contact

MIS technicians
Support desk

Write instructions

How to log onto system
What passwords to use
How to access programs
How to use email

Alarm System: Depending on the type of seizure activity, employees who had a seizure many not remember how to use an alarm system in the work environment.

Post copy of directions
Retrain how to use system
Change schedule so employee is never first person in or last person out

Limitations in Motor Abilities

Driving: Depending on the type of seizure activity, employees who have epilepsy or seizure activity may have driving restrictions.

Pair employee with co-worker who can drive to meetings or events
Reassign it to another employee, if driving is not an essential job function,
Transfer employee to a position that does not require driving as an essential job function
Adjust schedule so employee can access public transportation
Form a carpool with co-workers (to/from work)

Balancing/Climbing: Depending on the type of seizure activity, employees who have epilepsy or seizure activity may have difficulty balancing or climbing.

Use rubber matting on floor area to cushion a fall
Use stepping stands with handrails
Use rolling safety ladders with handrails and locking casters
Reassign this duty to another employee, if climbing is not an essential job function,
Provide head protection
Provide eye protection
Have arm rests on chairs to prevent falling out of chair

Fatigue: Employees with recent seizure activity, or who regularly use seizure medication, may experience fatigue.

Use anti-fatigue matting on the floor
Provide flexible start or ending times
Adjust workweek
Provide area to take nap during breaks or lunch

Ensuring safety in the workplace: Take some universal precautions to ensure that your agency is maintaining a safe workplace.

Designate a person to respond to emergencies
Keep aisles clear of clutter
Provide a quick, unobstructed exit
Post clearly marked directions for exits, fire doors, etc.
Know plan of action (practice)
Provide sensitivity training to employees
Know when to (or not to) call 9-1-1

Limitations Associated with Photosensitivity

Using Computer: If the employee has photosensitivity epilepsy, or other sensitivity to light, s/he may experience difficulty using a computer.

Use flicker-free monitor (LCD display, flat screen)
Use monitor glare guard
Use "computer glasses"
Take frequent breaks from tasks involving computer

Alternative Lighting: If the employee has photosensitivity epilepsy, or other sensitivity to light, s/he may experience seizures or headaches due to fluorescent lights or flickers from other lighting sources.

Replace fluorescent lights with full spectrum lighting
Turn off fluorescent lights
Use desk or floor lamps
Use natural lighting source (window) instead of electric light

Limitations in Sensory Abilities

Seeing/Hearing/Communicating: Depending on the type of seizure activity, employees may have limited ability, or no ability, to see, hear, or communicate while a seizure occurs. This limitation is usually temporary.

Allow employee time to recuperate from seizure (leave employee alone)
Identify hand signals or other universal signals that employee might use to communicate with another person
Assist employee in discontinuing activity such as carrying, climbing, or driving
Educate coworkers and supervisors on how to respond/react when employee has a seizure on the job
Consult employee's plan of action to determine how to respond/react when employee has a seizure on the job

Other Limitations

Attendance/Absenteeism: Depending on the type and frequency of seizure activity, employees with seizures may have attendance problems.

Allow employee to remain on the job after a seizure, if possible
Provide flexible schedule or workweek, if possible
Count all absences due to seizure activity as one occurrence

Schedule Issues: Depending on the medications and the type and frequency of seizure activity, employees with seizures may need adjustments to their work schedule.

Allow flexible start time or end time
Give employee time off while adjusting to medications
Work day shift instead of night shift
Work straight shift instead of rotating shift

Exhibiting Appropriate Behavior: Depending on the type of seizure activity, employees with seizures may have exhibit inappropriate behaviors in the workplace.

Understand employees limitations, and be prepared for behaviors such as:

Drooling or spitting
Urination on self or on furniture
Inappropriate behavior such as trying to push or kiss someone

Allow employee to keep change of clothes at the workplace
Provide private space for employee to go when exhibiting such behavior
Have employee alert co-worker/supervisor when seizure is about to occur
Provide sensitivity training/disability awareness to coworkers

Avoiding Seizures on the Job: Employees who have epilepsy or seizure disorders may be able to control seizure activity by using medications. However, other situations occur in the workplace that could create the onset of seizures. Try to reduce or eliminate these situations so seizure activity does not occur. Some triggers include:

Hormonal changes (pregnancy, menstruation, aging)
Sensitivity to fragrances or other chemicals in the workplace
Stress on the job
Disruption in daily activities due to working varied shifts (such as sleeping, taking medications, or eating)

To discuss accommodations for employees with epilepsy or seizure activity, or to discuss issues related to the ADA, contact JAN.

Accommodation Scenarios

An engineer with epilepsy had difficulty keeping projects going. JAN suggested color-coding projects, using an electronic organizer, using wall charts to track progress, and having the supervisor prioritize employee's tasks. The approximate accommodation cost is $275.

A laborer with epilepsy wanted to make her work area safe in the event of a seizure. JAN suggested installing machine guarding around her machine. The approximate accommodation cost is $475.

An educational consultant with epilepsy has driving restrictions. JAN suggested allowing other team member to drive to site-visit locations, working from home on non-site-visit days, communicating via email, and submitting paperwork electronically. The approximate accommodation cost is $1500.

A welder with epilepsy wanted to make his work area safe when he had a seizure. JAN suggested a welder's helmet with additional padding to protect his head and using an auto-stop switch on his welding torch. The approximate accommodation costs is $800.

An administrator with epilepsy needed an emergency alerting system as an accommodation. JAN suggested using a two way radio. JAN suggested creating a plan of action. The approximate accommodation cost is $100.

A student with epilepsy used hedge-cutters in a training program. JAN suggested using equipment with an auto stop trigger, steel shoes, shin guards, and protective gloves The approximate cost of the accommodation is $450.

A clerical employee fell when she had a seizure. JAN suggested creating a plan of action to respond to emergencies, using a 2-way radio to call for help, and providing a safe environment for her to go when a seizure is on-coming. The approximate accommodation cost is $100.

A telemarketer with epilepsy had difficulty learning new tasks. JAN suggested retraining, allow use of procedural manuals, and assigning one person to consistently help employee. The approximate accommodation cost is $60.

An office worker with epilepsy falls asleep at his desk. JAN suggested using an over-ear alarm to alert him when he falls asleep and programming a clock radio, egg timer, or wristwatch to alarm periodically. The approximate accommodation cost is $65.

A production employee with epilepsy needed personal safety equipment. JAN suggested safety gear, such as gloves, apron, and eye protection, as well as placing a rubber mat on floor to cushion a fall and creating a plan of action. The approximate accommodation cost is $700.

A retail sales employee with epilepsy had difficulty adjusting to new medications. JAN suggested providing leave during the doctor-recommended three week adjustment period. The approximate accommodation cost is $0.

A clerical employee with epilepsy falls out of his chair during seizure activity. JAN suggested using a chair without casters/wheels or a chair with locking casters/wheels. JAN also suggested padding the edges of the desk with corner caps or rubber strips. In addition, JAN suggested using a rubber mat on the floor to cushion a fall. The approximate accommodation cost is $400.

Product Listing

Many products identified as accommodations in this publication are commercially available. Please shop wisely before purchasing a product as an accommodation by comparing price and warranty, maintenance, availability, and usability.

In addition, JAN maintains a database of products and of manufacturers and distributors of products. Such information can be provided in print or electronic format upon request.

Any retail store or e-store where computers or computer accessories are sold should have the following items:

Flicker-free monitors
Flat screens and LCD monitors
Glare guards

Most home improvement stores, or other lighting specialty stores should have the following items:

Full spectrum lighting
Other alternative lighting (non-fluorescent lighting, task lighting, etc.)

Any retail store where electronics are sold should offer the following products:

2-way radios
Alarm clock radios
Alarm watches

Protective gear and safety equipment can be purchased commercially or e-commercially at contracting, industrial, or home improvement stores, or by mail order catalog:

Head protection
Eye protection
Hand protection
Safety rails
Machine guarding
Fall protection (safety harness)
Anti-fatigue mats
Ladders

RESOURCES
(This is a non-inclusive listing)