Access to Work Support Request

Request practical support to overcome a work-related barrier within the Havenstead Access to Work scheme.

Submission does not establish eligibility, approve support or expenditure, or create employment or appointment rights. If there is immediate danger or safeguarding risk, use the competent urgent-help route first.

Are you requesting support for yourself or referring someone else? (required)

If authorised referrer: name, organisation, role/relationship, safe contact, whether the person has been told, and authorised sharing basis where required

Name or safe identifier (required)

Preferred name, if different

Safe contact method (required)

Contact details (required)

Preferred communication format (required)

Accessibility or communication adjustment needed for this application process

Representative or supporter, if any

Havenstead work or participation route (required)

Employer, appointing authority or responsible organisation (required)

Role / position / work activity (required)

Current status: in role / confirmed start / returning / other (required)

Start or return date, if known

Work location or service, if relevant

Responsible organisation contact who can confirm the work arrangement, where applicable

Permission to contact that person for this application, where required

Describe the practical work-related barrier and how it affects the work (required)

What change or support do you think may help?

Practical support options

Communication or information format Assistive technology or software Equipment Human support Workplace or digital configuration Support to use approved equipment or technology Supported participation arrangement Other practical work-access support Unsure — I would like help identifying options

Has the responsible organisation already considered or made an ordinary reasonable adjustment or practical change? (required)

What has been tried or agreed?

What barrier remains?

Current support, equipment, software, service or human support related to this barrier

Existing DWS/NES/Skills Havenstead or other relevant case/reference number

Previous Access to Work reference

Evidence/document description

Evidence source

Evidence date, if known

Authorised evidence/reference route

Is there a date or event that makes this request time-sensitive? (required)

If Yes, date/event and why support is needed before or around it

Immediate safeguarding, serious safety, security or other specialist issue needing safe routing? (required)

If Yes, brief minimum necessary information or existing referral reference

Information-use and sharing acknowledgement (required)

I understand that DWS/NES may contact the responsible organisation or another competent service where necessary to validate the work route, assess the barrier, obtain specialist input or implement approved support, subject to the information-sharing rules that apply.

Contact, confidentiality or safety restriction before contacting another person or organisation

Declaration (required)

I confirm that the information provided is accurate to the best of my knowledge. I understand that submitting this request does not itself establish eligibility, approve support or expenditure, create an employment or appointment right, or replace another authority’s decision.

Services and information

Government activity

Access to Work Support Request