Let Vero draft the letter.
Paste this template into Vero once, and it drafts each letter from the visit, with the limits and dates you discussed, for you to check and export to PDF or Word.
Pregnancy Accommodation Letter Template
A pregnancy accommodation letter tells an employer what your pregnant or postpartum patient needs changed at work, and for how long. Copy the template, see a lifting-limit example and a nausea example, and check what the official rules let an employer ask for.
- Free, no account needed
- Word and text downloads
- Two filled examples
Blank pregnancy accommodation letter template
FreePREGNANCY ACCOMMODATION LETTER [Practice name] [Address] [Phone and email] Date: [Date you write the letter] To: [Employer, human resources, or occupational health contact] Re: [Patient's full name] Date of birth: [Date] Job title: [Job title, if known] [Patient name] asked me for this letter and agreed to what it shares. ASSESSMENT I assessed [patient name] [in person, by video, or by phone] on [date of the visit]. Pregnancy: [Pregnant, or gave birth on date. Add weeks or the due date only if the patient agrees and the employer needs it] LIMITATION [What the patient can't do or needs, in plain words, e.g. pain when lifting heavy loads, needs to eat every 2 to 3 hours, or needs regular prenatal appointments] This limitation is related to [the pregnancy, recovery from childbirth, or a related condition]. CHANGES NEEDED AT WORK Lifting and carrying: [Limit, e.g. no lifting over 9 kg / 20 lb, nothing from the floor or above shoulder height, or none] Breaks: [How often and how long, e.g. a 10-minute seated break every 2 hours, or none] Sitting and standing: [e.g. a chair or stool at the workstation, or none] Hours and schedule: [e.g. no shifts starting before 10:00, no night shifts or overtime, or none] Remote work: [e.g. work from home on appointment days, if the job allows, or none] Appointments: [About how often and how long, e.g. every 2 weeks for 2 hours, or none] Tasks or hazards to avoid: [e.g. ladders, named chemicals, or none] Other: [Any other change, or none] DURATION From: [Start date] Until: [End date, the start of leave, or the review date] Review: [Date you will reassess and update this letter] DIAGNOSIS [Not included, or with the patient's consent: the condition in words they agreed to] [Your name, credentials] [License or registration number] [Signature] Questions about these changes: [Practice phone or email]
Use it for
- Lifting and carrying limits
- More breaks and a place to sit
- Later starts and schedule changes
- Time off for prenatal appointments
- Remote work or a change of task
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
Pregnancy accommodation letter: warehouse worker at 24 weeks
Family practice, routine prenatal visit; letter for the employer’s human resources team
Patient
31-year-old order picker at a distribution warehouse, 24 weeks pregnant. Her employer asked for a note to support her request, and she agreed to what the letter shares.
Assessment
I assessed her in person on Wednesday, October 14, 2026.
Limitation
She has low back and pelvic pain when she lifts heavy cartons or bends to the floor, and needs to rest off her feet during a shift. Both are related to her pregnancy.
Changes needed
No lifting or carrying over 9 kg / 20 lb, and nothing from the floor or above shoulder height. A 10-minute seated break every 2 hours, on top of her usual breaks, and a stool at the packing station.
Duration
From Thursday, October 15, 2026, until her pregnancy leave starts. I will review these limits at her prenatal visit on Wednesday, December 9, 2026, and update this letter if they change.
Diagnosis
Not included. The limits are described instead.
Signed
Family physician, with credentials, license or registration number, and signature, on practice letterhead, with the practice phone for questions about the limits. Issued October 14, 2026.
Pregnancy accommodation letter: nurse with hyperemesis, 6 weeks
Midwifery practice, in-person visit; letter for the hospital’s occupational health office
Patient
28-year-old registered nurse on a hospital medical ward, 11 weeks pregnant. She has told her manager she is pregnant, and asked for this letter.
Assessment
I assessed her in person on Thursday, October 15, 2026.
Limitation
She has severe nausea and vomiting related to her pregnancy, worst from waking until mid-morning. She can work safely later in the day, but needs to eat small amounts often, and may need to leave the unit for a few minutes at short notice.
Changes needed
No shifts that start before 10:00. Short breaks off the unit when she needs them, to eat, drink, or be sick, with another nurse covering her patients. A place off the unit to keep water and snacks.
Duration
6 weeks, from Monday, October 19, to Sunday, November 29, 2026. I will reassess her on Thursday, November 26, 2026, and write an updated letter if the changes need to continue.
Diagnosis
Not included, at her request. The nausea and vomiting, and what she needs because of them, are described instead.
Signed
Registered midwife, with registration number and signature, on practice letterhead, with the practice phone for questions about the changes. Issued October 15, 2026.
When an employer can ask for a note, and what it says. Checked October 2026.
These rules set when an employer can ask for documentation of a pregnancy accommodation, and what it needs to say. State and provincial laws, collective agreements, and the employer’s policy can add more.
United States, federal
The Pregnant Workers Fairness Act applies to employers with 15 or more employees. Often a conversation is enough and no note is needed. When an employer may ask, it is limited to documentation that confirms the condition, which needn’t be a diagnosis, confirms it relates to pregnancy, childbirth, or a related condition, and describes the change needed, such as no lifting over 20 pounds for 3 months.
United States, federal: when no note is needed
Under the EEOC’s rule, it isn’t reasonable to ask for documentation when the limitation and the change are obvious, when the employer already has enough information, or when the change is available to other employees without a note. Nor when a pregnant employee confirms that she needs water, more restroom breaks, to sit or stand, or breaks to eat and drink, or when an employee confirms a need to pump or nurse at work.
United States, federal: who can write it
An employer can require that the documentation come from a health care provider, such as a doctor, midwife, nurse, nurse practitioner, physical therapist, lactation consultant, doula, or psychologist, who may be a telehealth provider. It can’t require a specific form, require the provider treating the condition, or require an exam by a provider it chooses.
Ontario
Where necessary, a pregnant worker should provide documentation of her accommodation needs from professionals. She shouldn’t be asked for documentation of changes that are obvious or normal in any pregnancy, such as more washroom breaks, a reduced ability to stand for long periods late in pregnancy, or regular medical appointments, and a breastfeeding worker shouldn’t be asked for proof of the need to breastfeed. The employer should bear the cost of any medical documentation needed.
Canada, federally regulated employers
From the start of pregnancy to the end of the 24th week after the birth, a pregnant or nursing employee can ask to have her job modified or to be reassigned if her current work may pose a risk to her health, or that of the foetus or child. The request comes with a certificate from a health care practitioner of her choice, giving how long the risk is expected to last and the activities or conditions to avoid.
Québec
If the professional giving pregnancy or postnatal care thinks the working conditions are physically dangerous for the worker, her unborn child, or her breastfed child, they complete the CNESST’s Reassignment or preventive withdrawal certificate, a form. If no CNESST protocol matches the job, they must consult the workplace’s health services physician or the regional public health director for a medical-environmental report. The signed certificate is the worker’s request for reassignment.
What goes in each part.
Practice, patient, and consent
Who wrote the letter, who it is about, and that the patient agreed to what it shares.
- Your practice’s name, address, and phone, on letterhead
- The patient’s full name, date of birth, and job title, if known
- Who it goes to: the manager, human resources, or occupational health
- That the patient asked for the letter and agreed to its content
Avoid: Telling the employer about the pregnancy before your patient has. Early on, ask what they want to share first.
Pregnancy and limitation
That the patient is pregnant or recovering from childbirth, and what they can’t do or need because of it.
- Pregnant, or the date of the birth if postpartum
- The limitation in plain words: pain when lifting, nausea, fatigue on long shifts, appointments
- That the limitation is related to the pregnancy, childbirth, or a related condition
Avoid: Obstetric history, test results, or past pregnancies. The employer doesn’t need them to make the change.
Changes needed at work
Each change the patient needs, in words a manager can act on the same day.
- A number wherever you can: a weight, minutes, hours, how often
- Tasks or hazards to avoid, by name
- How often prenatal appointments are, and about how long each takes
- “None” on the lines that don’t apply
Avoid: “Light duties” or “as tolerated.” Say what the patient can’t do, and what they need instead.
Duration and review
When the changes start and end. Needs change as the pregnancy goes on, so set a point to look again.
- The start date
- An end date, the start of leave, or a review date
- The date you will reassess and update the letter
Avoid: “For the rest of the pregnancy” with no review, when the limits will likely change before then.
Diagnosis
Usually left out. A plain description of the limitation is often enough for the employer to act.
- Only with the patient’s consent
- In the words they agreed to, such as “nausea and vomiting of pregnancy”
- Nothing about a complication they haven’t agreed to share
Avoid: Naming the condition because the employer’s form has a box for it. Describe the limitation instead.
Signature and contact
Your details, so the employer knows who wrote the letter and who to ask about the changes.
- Your name and credentials
- Your license or registration number
- Your signature
- A phone number or email for questions about the changes
Avoid: Answering an employer’s questions beyond the letter without the patient’s consent. Confirm you wrote it, and send anything more through the patient.
Common mistakes, and how to avoid them.
Sharing the pregnancy before the patient has
Early in pregnancy, your patient may not have told work yet. Ask what they want the letter to say before you write it.
History no one needs
The employer needs the limitation, that it relates to the pregnancy, and the change. Leave out obstetric history, test results, and past pregnancies.
Limits without numbers
“Light duties” means something different to every manager. Give a weight, a break length and how often, or the hours they can work.
No review date
What a patient needs at 12 weeks isn’t what they need at 32. Give an end date, the start of leave, or the date you will review.
A long letter for a routine need
Some of the rules above say employers shouldn’t ask for a note for routine needs, such as more bathroom breaks or a chance to sit. If your patient needs one anyway, keep it to the need and how long.
Try Vero free
Frequently asked questions.
What should a pregnancy accommodation letter include?
That your patient is pregnant or postpartum, the limitation in plain words, each change they need at work, and when the changes start and end or will be reviewed. Sign it with your name, credentials, and license or registration number. Leave out the diagnosis and obstetric history unless the patient agrees.
How do I write pregnancy work restrictions?
Make each one specific: a weight limit, how long and how often breaks are, the tasks or hazards to avoid, and the hours they can work. Add an end or review date, since needs change as the pregnancy goes on.
Can an employer ask for a doctor’s note for pregnancy accommodation?
Sometimes. Some rules let an employer ask only when a note is reasonable, and not for obvious or routine needs such as water, bathroom breaks, or a chance to sit. The table above shows the official rules for several places.
Does the letter have to include the diagnosis?
Usually not. The employer needs to know that the limitation relates to the pregnancy, and what change is needed. A plain description, such as nausea and vomiting or pain when lifting, is often enough. Name a diagnosis only with the patient’s consent.
Who can write a pregnancy accommodation letter?
Usually the clinician giving prenatal or postpartum care: a physician, nurse practitioner, or midwife. Some rules accept other providers too, such as nurses, physical therapists, or lactation consultants, including by telehealth. Check the table above for where you practise.
How long should a pregnancy accommodation last?
As long as the limitation does. A lifting limit may last until leave starts; a later start for morning nausea may last a few weeks. Give an end or review date, and update the letter if the need changes.
Show all questions
What if my patient needs to stop work?
If they can’t work at all, for a complication, bed rest, or an early start to leave, write a medical leave letter instead, with the dates off and a review date.
Who pays for a pregnancy accommodation letter?
It depends on where you practise and the employer’s policy. Some human rights guidance says the employer should pay for medical documentation it needs; see the table above.
Is this pregnancy accommodation letter template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
Can Vero write a pregnancy accommodation letter from my visit?
Yes. Paste this template into Vero, and it drafts the letter from your visit, with the limits and dates you discussed. Review and edit it, then export it to PDF or Word, print it, or email it.
More templates, and guides.
Doctor’s note template
For work or school: the visit, the dates off, the return, and any limits.
Return-to-work note template
To an employer: full or modified duties, the restrictions, how long they last, and the review date.
Medical leave letter template
To an employer or leave administrator: when the leave starts, how long it lasts, the review date, and what the return needs.
Workplace accommodation letter template
To an employer: what the condition limits, the change that would help, how long, and answers to the employer’s questions.
Lactation accommodation letter template
For pumping or breastfeeding at work: the breaks, the space, any medical reason, and an end date.
Vero Documents
Fill employer, leave, and benefit forms from the visit and the chart.
Your template. Filled in from the visit.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
Try Vero free
No credit card required. 10 free actions every month.