Examples of how to fill in an ET1 form for a disability discrimination claim
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Example of a completed ET1 form in a case about applying for a job.
The claim is for direct discrimination and failure to make reasonable adjustments.
Mr Yates’ story
Mr Yates is partially sighted and registered blind. He sees a job as a clerical officer advertised in his local newspaper. When Mr Yates telephones to ask for an application form, he explains that, because of his visual impairment, he will need the application pack in large print (font size 18). The employer tells him this is not possible and that the job has now been filled.
When a friend of Mr Yates telephones for an application pack later the same day, she is sent the form a few days later.
Mr Yates’ claim
Mr Yates identifies that:
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the employer’s reason for refusing to send him an application was on the grounds of his disability – the employer refused without considering Mr Yates’ abilities to do the job; it is unlikely they would have treated someone who is not blind in the same way
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the employer knew about Mr Yates’ disability and that he had requested a reasonable adjustment
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the employer’s refusal to provide the application form in different formats put Mr Yates at a substantial disadvantage
Example of how to complete an ET1 form in this case
This example is based on the print version ET1 form but it will also help in completing the online form at http://www.employmenttribunals.gov.uk
1. Your details
1.1 Title Mr
1.2 First name(s) Frederick
1.3 surname or family name Yates
1.4 date of birth 19/05/1949
1.5 Address 23 Knott Lane, New Town, NW1 1AB
1.6 Phone no (during working hrs)
1.8 How would you prefer us to communicate with you? tick ‘by letter’
2. Respondent’s details
Busy Bee Cleaning Company, New Town, NW7 5CC
3. Action before making a claim
3.1 No
3.2 No (because answer is no – go straight to section 6 of the form)
3.3
3.4
3.5
3.6
3.7
4. Employment details
4.1
4.2
4.3
4.5
5. Unfair dismissal or constructive dismissal
6. Discrimination
6.1 Please tick the box or boxes to indicate what discrimination you are complaining about.
Tick ‘disability’ box
6.2 Please describe the incidents which you believe amounted to discrimination, the dates of these incidents and the people involved:
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I am partially sighted and registered blind. I am a disabled person for the purposes of the Disability Discrimination Act.
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On 10 May 2005, I saw a job advertised in the Evening Reporter for the post of clerical officer at Busy Bees Ltd.
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On 11 May, I telephoned the company and spoke to Mr Pearce in their Human Resources department. I asked Mr Pearce to send me an application pack. He asked me about my qualifications/experience and agreed to send out the pack.
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When I then told him that I was partially sighted and would need the application pack in large print, Mr Pearce replied that the clerical officer post had been filled and he would not be sending me an application pack.
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I was very surprised at this. Later that same day, a friend of mine, who is not disabled, rang the company about the clerical officer vacancy. She was asked about her qualifications and was told an application pack would be posted to her. She received the pack a couple of days later.
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On 17 May, I wrote to the managing director explaining what had happened to me and asking again for an application form. I waited three weeks and did not get a reply.
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On 13 June, I sent the employer a DL56 questionnaire. I sent them a reminder letter about my DL56 form on 17 July. I have not received any replies yet.
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I believe that the reason the employer refused to send me an application pack was because I am a disabled person. This is unlawful disability discrimination.
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I believe the employer failed to make a reasonable adjustment by not providing the application pack in large print or another suitable format.
7. Redundancy payments
Leave blank – not relevant to this claim
8. Other payments you are owed
Leave blank – not relevant to this claim
9. Other complaints
Leave blank – not relevant to this claim
10. Other information
Leave blank – not relevant to this claim
11. Your representative
Please sign and date here
F. Yates
25 July 2005
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Example of how to complete an ET1 claim form in a reasonable adjustments case
Mrs Shaw's story
Mrs Shaw has worked as a shop assistant for a large retail company for five years. Her duties include serving customers, carrying large heavy items from the stock room to the front of the shop. She is also responsible for updating stock records on the computer. The employer also operates a mail order telesales business from the same premises.
Six months ago, she had a stroke and as a result she has restricted movement in her right arm and difficulty lifting and carrying large items. The company knows of Mrs Shaw's disability. She has medical reports which show that, because of her impairment, she should not lift or carry heavy items. She asks the employer to consider a number of adjustments including:
- providing help with the lifting
- transferring those duties to another employee
- transferring her to another post in the organisation such as office work or based in the telesales department
- retraining
The employer does not make any adjustments. They say that the adjustments Mrs Shaw has asked for are not practical and too expensive.
Mrs Shaw's claim
Mrs Shaw identifies that:
- the employer's practice of requiring her to lift heavy items places her at a substantial disadvantage because she cannot carry heavy items
- without adjustments being made, she cannot carry out that aspect of her job
- she needs to have informed them of her disability. It is also helpful for her to suggest adjustments that could be made to meet her requirements
- she does not need to compare herself with anyone
the employer has not made any adjustments
Mrs Shaw can argue that her employer has failed in its duty to make reasonable adjustments as it has failed properly to consider or make any adjustments to accommodate her condition.
Mrs Shaw will be successful in her claim unless the company can give reasons to explain why these adjustments cannot be made. If they are able to provide a good explanation as to why it is not reasonable to make any of the adjustments, then her claim is likely to fail.
Example of how to complete an ET1 form in this case
This example is based on the print version ET1 form but it will also help in completing the online form at www.employmenttribunals.gov.uk
1 Your details
1.1 title Mrs
1.2 first name Juliette
1.3 surname of family name Shaw
1.4 date of birth 04/04/1953 female
1.5 address 4 Mint Street, Oxdown, OX12 9EE
1.6 phone number (during working hours) 07700 500500
1.7 how would prefer us to communicate with you? by post
2 Respondent's Details
2.1 Slashpenny Ltd
2.2 Registered office', 15 Verney Lane, Lower Bidwater, Wiltshire
2.3 Slashpenny Store, Clarendon Way, Oxdown, OX1 7HJ
2.4 not applicable
3 Action before making a claim
3.1 Yes
3.2
3.3 No
3.4
3.5 Yes - on 16/05/05
3.6 Yes
4 Employment Details
4.1 04/09/2000 continuing
4.2 shop/stockroom assistant
4.3 40 hours each week
4.4 pay before tax £989.06 each month normal take home pay
(including overtime, commission and so on) £947.22
4.5 not applicable
5 Unfair dismissal or constructive dismissal
5.1
5.2
5.3
5.4
5.5
5.6
5.7
6 Discrimination
6.1 tick 'disability'
6.2 please see attached sheets (for print version):
Attached 6.2 statement
- I believe I am a disabled person for the purposes of the Disability Discrimination Act 1995.
- In January 2005, I had a stroke. As a result of the stroke, I now have limited movement and strength in the right side of my body. In particular, the movement and strength in my right arm is very restricted. I am under the care of a consultant at my local hospital and he has told me it is very unlikely that I will ever get improved movement/strength in my right side.
- Because of my disability I have difficulty lifting and carrying. For example, I cannot carry shopping bags or lift a kettle. I also find it difficult to use a knife and fork at the same time (although I can use an adapted keyboard). My balance is affected. For example, I can only use stairs and steps very slowly and using a banister for balance. I get tired quickly and cannot walk for more than 10 minutes without a rest.
- I started work at Slashpenny Ltd in September 2000. I work as a shop/stockroom assistant. My duties include serving customers and carrying large, heavy items of stock from the stock room to the front of the shop. I am also responsible for updating stock records on the computer.
- The respondent is a large retail company with a number of shops, as well as a mail order business which is based at the Oxdown store and offices where I work. There are usually job vacancies in all areas of the company, including administrative roles which do not involve any heavy lifting.
- After my stroke I was off sick for two months. When I went back to work, I was advised by my doctor that I should not carry or lift heavy/large items or do other heavy physical work. My consultant confirmed this in a letter which I gave to my manager on 21 March 2005 (my first day back in work).
- I assumed that my manager would read the doctor's letter and take appropriate action. In the meantime, I had to cope with the heavy lifting part of my job by asking colleagues to move the large/heavy stock items for me, by using trolleys to move smaller/lighter stock items and moving them at a slower pace. If no colleague was available to help me, the heaviest/largest stock items had to stay in store room.
- Between 21 March and 11 April 2005, I mentioned the difficulties I had with lifting to my manager several times. I explained that I needed an adjustment and was unhappy to rely on my colleagues' goodwill and have no proper arrangements in place. My manager said she would have to discuss things with Human Resources (HR) and get back to me. Nothing happened.
- On 11 April 2005, I wrote to both my manager (Tracy McCormack) and HR asking for reasonable adjustments. In my letter I reminded them about my doctor's report and made several suggestions about potential adjustments (ie. transferring lifting duties to a colleague, re-deploying me to an admin role).
- On 20 April, I met with my manager to discuss my written request for reasonable adjustments. Tracy told me that the company would probably want to carry out a risk assessment or refer me to their occupational health specialist before deciding what steps to take. Tracy repeated that she would speak to HR and get back to me.
- I waited four weeks but as I heard nothing further from my manager or occupational health I asked for a meeting with Elaine Stowe, HR Manager.
- At our meeting on 12 May, I was shocked when Elaine told me that I was expecting 'special treatment' by asking for reasonable adjustments. Elaine said that the reasonable adjustments I'd asked for were 'simply not practical' or 'cost effective for such a junior member of staff'.
- Elaine was unwilling to discuss my request for adjustments further and ended the meeting.
- On 16 May 2005, I made a formal written grievance (under both company and statutory grievance procedures) about the respondent's failure to make reasonable adjustments.
- The grievance meeting took place on 7 June 2005 and I received my employer's written decision on 9 June 2005. The decision stated that there were no reasonable adjustments that could be made. The reasons given were that i) it was not fair to give other employees extra lifting duties ii) other adjustments would cost too much and iii) there were no other vacancies at Slashpenny at that time.
- On 9 June, I appealed the grievance decision on the grounds that: i) there are ten shop/stock assistants and sharing lifting duties among them would not be onerous ii) to my knowledge my employer has never approached Access to Work who may pay the cost of adjustments iii) I knew there were vacancies in the wages and mail order departments at that time.
- On 10 June, the employer wrote to tell me my appeal was unsuccessful. They did not give any reasons why.
- Since 23 May 2005, I have been signed off sick by my doctor because without adjustments at work my health is at risk. My doctor has recommended that I do not return to work until appropriate reasonable adjustments are in place.
- I have been very upset by the company's failure to make reasonable adjustments when they have medical evidence showing that I need these. I believe that Slashpenny are not taking reasonable steps to make adjustments and to enable me to return to work.
- My claim is that the respondent's refusal to make reasonable adjustments is unlawful discrimination contrary to the Disability Discrimination Act.
- I am seeking:
- compensation (including compensation for loss of earnings; damages for injury to feelings; and interest thereon)
- a declaration by the tribunal of my rights under the DDA;
- a recommendation by the tribunal that the respondent makes reasonable adjustment(s) within a specified time
7 Redundancy payments
not applicable - leave blank
8 Other payments you are owed
not applicable - leave blank
9 Other complaints
not applicable - leave blank
10 Other Information
not applicable - leave blank
11 Your representative
not applicable - leave blank
Sign and date here
Juliette Shaw 14/6/2005
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Example of how to complete an ET1 claim form in a case of harassment and victimisation
Mr Griffiths' story
Mr Griffiths has a learning disability. He is often called 'stupid' and 'slow' by one particular colleague at work. This colleague, Eddie, tries to encourage other workmates to join in this name-calling.
Mr Griffiths' claim
Eddie's treatment of Mr Griffiths will probably amount to harassment, whether or not Mr Griffiths was present when the comments were made, because they were said with the intention of humiliating him
Example of how to complete an ET1 form in this case
This example is based on the print version ET1 form but it will also help in completing the online form at http://www.employmenttribunals.gov.uk
1. Your details
1.1 title Mr
1.2 first name David
1.3 surname or family name Griffiths
1.4 date of birth 09/07/1979
2. Respondent's details
2.1 Large Company Ltd
2.2 Large Company House, Bradshaw Street, Scattersby, Essex CW22 9PX
3. Action before making a claim
3.1 Yes
3.2
3.3 No
3.4
3.5 Yes 11/05/05
3.6 Yes
4. Employment details
4.1 12/12/03 Yes
4.2 Administrative Assistant, Human Resources
5. Unfair dismissal or constructive dismissal
Not applicable
6. Discrimination
6.1 tick 'disability'
6.2 see attached sheets
Statement for section 6.2 of claim form
1. I have a learning disability. This makes it very difficult for me, for example, to follow instructions such as a simple recipe or a short list of domestic tasks. I have a support worker who helps me with household tasks such as laundry, cleaning and shopping. I believe I am a disabled person for the purposes of the Disability Discrimination Act 1995.
2. The respondent is a large company. I work in the human resources department as an Admin Assistant. My team includes Eddie Thomas.
3. At first, Eddie was polite to me as were the other members of the team. But over the last few months Eddie has started making comments about my disability. He has called me 'slow', 'stupid' and a 'thicko' many times.
4. On 5 May 2005, I was having difficulty completing a piece of work for my manager. When I asked a colleague for help, Eddie interrupted and called me 'slow' and 'just plain stupid'. He said this in front of my manager, Sue Sperritt, and other workmates.
5. Even though Eddie made these comments in front of her, Sue Sperritt did not tell him to stop.
6. The next day (6 May), I asked to speak to Sue in private. I told her how upset and humiliated Eddie's comments made me feel. I explained that Eddie had been making these comments for a while
7. I did not find it easy to speak to Sue about what was happening. And I was shocked when she said I was being too sensitive and that Eddie's remarks were 'only a joke' and 'just office banter'. She did not take my complaint seriously and stated that Eddie meant nothing by the comments.
8. On 11 May 2005, I sent a formal grievance letter to the head of human resources. I have now waited more than the 28 days required by the statutory dispute rules. But my employer still has not replied to my letter, arranged a grievance hearing or taken any other action about my complaint.
9. Since I made a grievance, Eddie Thomas and two other members of my team have started to ignore me at work. I think this is because Eddie Thomas knows that I have made a complaint about harassment and disability discrimination. I believe this is victimisation.
10. I believe that I have been harassed because of my disability. My employer's failure to take any action to investigate or stop the harassment amounts to unlawful disability discrimination.
11. My claim is for harassment and victimisation.
12. I would like compensation, including damages for injury to feelings. I would also ask the tribunal to recommend steps the employer should take to stop the harassment and victimisation.
7. Redundancy payments
blank
8. Other payments you are owed
blank
9. Other complaints
blank
10. Other information
blank
11. Your representative
blank
Signature and date
David Griffiths
21 June 2005
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Example of how to complete an ET1 claim form (ET1) in a case involving more than one type of disability discrimination (direct discrimination, reasonable adjustments, disability related discrimination)
Mr Khan's story
Mr Khan has bipolar disorder. He worked for a large employer as a customer services adviser. The employer knew of his disability when they appointed him. Sometimes, Mr Khan found it difficult to cope with the pressure of the work. His performance deteriorated as a result.
The company referred Mr Khan to their occupational health adviser. The adviser's view was that Mr Khan had difficulty in coping with pressure because of his disability. The adviser recommended that adjustments be made, including transferring him to another less pressured position and adjusting his hours.
The employer took no action on these recommendations even though there were vacant posts in other departments. Mr Khan remained in his original position where his work continued to deteriorate. The employer has a 'poor performance procedure', which is applied to all employees whose performance is giving cause for concern and applied this to Mr Khan. He was given a verbal warning and an action plan requiring a substantial improvement within four weeks, which merely increased the pressure on him. As a result, Mr Khan's performance failed to improve and he was dismissed.
Mr Khan's claim
Mr Khan identifies that
and
Mr Khan needs to
and
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consider whether making a reasonable adjustment would have made a difference to the outcome. That is, had adjustments been made, would his performance have met the required standard and the poor performance procedure not have been applied?
Mr Khan probably has a claim of disability-related discrimination and failure to make reasonable adjustments.
It is unlikely that the employer will be able to justify the discrimination. They did not make reasonable adjustments, despite having been given expert advice recommending steps to take. Had the employer made reasonable adjustments to Mr Khan's job, it is likely that his performance would have improved and he would not have been subjected to the poor performance procedure.
Then, after his dismissal, Mr Khan found out from an ex-colleague that other customer services advisers who did not meet performance targets were transferred to different jobs in the company.
If what the colleague says is true and Mr Khan can find evidence to prove it, he may now have a direct discrimination claim as well as his original claims of failure to make reasonable adjustments and disability-related discrimination.
A direct discrimination claim will be harder for Mr Khan to prove. But it is better for Mr Khan to include direct discrimination on his claim form (ET1) now and remove it later if necessary.
This example of a completed claim form shows you how to fill in the form when your claim is for more than one type of disability discrimination.
This is shown in paragraph 21 of the statement at section 6.2 of the form.
Example of how to complete an ET1 form in this case
This example is based on the print version ET1 form but it will also help in completing the online form at www.employmenttribunals.gov.uk
1. Your details
1.1 title Mr
1.2 first name Tariq
1.3 surname or family name Khan
1.4 date of birth 19/10/1970
2. Respondent's details
2.1 A1 Calls Ltd
2.2 Heightsroyd House, Crashaw Avenue, Halifax, West Yorkshire HX1 9YP'
3. Action before making a claim
3.1 Yes
3.2
3.3 Yes
3.4 Yes
3.5 Yes 15/04/05
3.6 Yes
4. Employment details
4.1 04/10/02 11/04/05 No
4.2 Customer Services Advisor
4.3 37.5
4.4 £200 £245
4.5 Yes
5. Unfair dismissal or constructive dismissal
I believe my dismissal was because of unlawful disability discrimination and therefore it is automatically unfair.
6. Discrimination
6.1 tick 'disability'
6.2 please see attached sheets
Statement for section 6.2 of claim form
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I believe I am a disabled person for the purposes of the Disability Discrimination Act.
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I have had bi-polar disorder since I was 20. It is a recurrent condition and I am likely to have the symptoms for the rest of my life.
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I take regular medication. This helps manage the symptoms of my condition. However, without my medication I would experience a substantial adverse effect on my day to day activities because of my disability.
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I find it difficult to concentrate and get easily confused. For example, I cannot follow simple directions and in an unfamiliar place I would get lost. I have difficulty understanding a bus or train timetable. I cannot read a newspaper or follow a half hour television programme. I neglect my personal safety and hygiene. For example, I will miss meals and lose weight rapidly.
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The respondent is a large company. I worked there for three years as a customer services advisor. The position involved taking calls and processing complaints and service enquiries. It was a high volume, frontline position, which required careful attention to detail and the ability to work quickly and efficiently at all times. I often had to deal with callers who were upset or angry.
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The respondent knew I have bi-polar disorder. When I was first offered the job they asked me to fill in a medical questionnaire and I gave full details of my disability.
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For the first year or so I was able to cope with the job, but around the summer of 2004 the symptoms of my condition started to get worse.
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I started to struggle with my workload because of the difficulty I had concentrating, even when on medication. The increased anxiety my condition causes meant that I often got upset and tearful when I had to deal with difficult calls.
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As a result, my manager, Daniel Robinson, asked me to a meeting in January 2005 to discuss my performance. We both agreed that I should be referred to the company's occupational health adviser.
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I met with the occupational health adviser on 18 February 2005 and received a copy of the occupational health report on 2 March 2005.
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The report said that I was having difficulty in coping with the pressure of the job because of my disability. The report made recommendations for reasonable adjustments including:
- I was aware that there were administrative roles in other departments. These did not involve dealing with high call volumes and I believe I had both the skills and experience to do these jobs. I had discussed these options with the occupational health doctor at our meeting.
- On 11 March 2005, I met with my manager to discuss the occupational health report but no agreement was reached over the reasonable adjustments suggested. In particular, Mr Robinson refused to consider transferring me to another department, even though there were vacancies (for example, in the finance department) at that time. Daniel Robinson suggested that my 'mental health issues' would be 'a problem' whatever department I worked in.
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After this meeting, I was very upset as I felt that I was not being listened to. In particular, Mr Robinson's comment about my disability being 'a problem' undermined my confidence. My condition got worse and my medication was increased. Despite this I continued to try and do my job.
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On 21 March 2005, I was given a verbal warning. The warning is the first step of the company's 'poor performance' procedure. I was also given an 'action plan' which stated that my performance must 'substantially improve' within 4 weeks. The action plan called for an increase in volume call handling of 20% and required that I complete all administrative tasks with 97% accuracy.
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I did not get any training or support during the 4 week action plan period and working under the additional pressure of the 'poor performance' procedure without reasonable adjustments made my condition worse. As a result, I was unable to improve.
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On 11 April 2005, I attended a meeting with my manager. I had been told about the meeting a few days beforehand and that because it was about the poor performance procedure I could bring a work colleague with me.
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At the meeting, I was told my work performance had not improved and that I was dismissed with immediate effect.
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On 17 April 2005, I appealed against my dismissal. In my appeal letter I explained my complaint that reasonable adjustments had not been made despite the recommendations of the respondent's own occupational health experts.
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On 22 April 2005, I got a letter from A1 Calls telling me that my appeal had been unsuccessful.
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My claim is for:
Direct discrimination
A1 Calls treated me less favourably on the grounds of my disability - in the past other customer service advisers who have not met targets have been moved to another job or allowed to work part-time hours. I believe it is only because I have a mental health impairment that I was dismissed. But for my impairment the employer would not have dismissed me.
Also, or in the alternative:
Disability related discrimination
I have been discriminated against for a disability related reason - it was for reasons relating to my disability that I was dismissed for poor performance
And:
Failure to make reasonable adjustments
The respondent has discriminated against me by failing to making reasonable adjustments, as recommended by its own occupational health expert in her report dated 2 March 2005
22. I am seeking compensation, including compensation for loss of earnings; damages for injury to feelings and any personal injury arising from the acts of discrimination. Interest thereon
7. Redundancy payments
leave blank
8. Other payments you are owed
leave blank
9. Other complaints
leave blank
10. Other information
leave blank
11. Your representative
Leave blank
Please sign and date here
T. Khan 20/05/05
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