html7.2 KB
Workplace Accommodation Request (HTML)
An adjustment request built around what somebody needs rather than why, so it collects no health information at all. Useful as an accessible-form reference and as a counter-example to intake forms that ask for a diagnosis.
Preview — first 39 lineshtml
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Workplace accommodation request - Novus Examples</title>
<meta name="description" content="An adjustment request that asks about needs, never about diagnoses. SAMPLE test data only.">
<style>:root{--bg:#f6f7f9;--card:#fff;--fg:#1a1d23;--muted:#5b6472;--border:#d9dee6;--accent:#0f9d6b;--accent-d:#0c7f56;--err:#d33;--radius:10px}*{box-sizing:border-box}body{margin:0;font:16px/1.5 system-ui,-apple-system,'Segoe UI',Roboto,sans-serif;background:var(--bg);color:var(--fg);padding:2rem 1rem}.wrap{max-width:640px;margin:0 auto}.card{background:var(--card);border:1px solid var(--border);border-radius:16px;padding:1.75rem;box-shadow:0 1px 3px rgba(0,0,0,.05)}h1{margin:0 0 .25rem;font-size:1.55rem}.lead{margin:0 0 1.5rem;color:var(--muted)}form{display:grid;gap:1.1rem}.field{display:grid;gap:.35rem}label{font-weight:600;font-size:.92rem}.req{color:var(--err)}.hint{font-size:.8rem;color:var(--muted)}input,select,textarea{font:inherit;color:inherit;background:#fff;border:1px solid var(--border);border-radius:var(--radius);padding:.6rem .7rem;width:100%}input:focus,select:focus,textarea:focus{outline:2px solid var(--accent);outline-offset:1px;border-color:var(--accent)}textarea{resize:vertical;min-height:110px}input[type=range]{padding:0}input[type=color]{height:44px;padding:.25rem}input[type=file]{padding:.45rem}.group{display:grid;gap:.45rem}.opt{display:flex;align-items:center;gap:.55rem;font-weight:400}.opt input{width:auto}.inline{display:flex;flex-wrap:wrap;gap:1rem}fieldset{border:1px solid var(--border);border-radius:12px;padding:1rem;margin:0}legend{font-weight:600;padding:0 .4rem}.hp{position:absolute!important;left:-9999px;width:1px;height:1px;overflow:hidden}button{font:inherit;font-weight:700;cursor:pointer;border:0;border-radius:var(--radius);padding:.7rem 1.3rem}.btn{background:var(--accent);color:#fff}.btn:hover{background:var(--accent-d)}.btn-ghost{background:transparent;color:var(--muted);border:1px solid var(--border)}.actions{display:flex;gap:.6rem;flex-wrap:wrap;margin-top:.3rem}.ok{display:none;background:#e7f7ef;border:1px solid #b6e6cf;color:#0c7f56;border-radius:var(--radius);padding:.7rem .9rem;font-size:.9rem}.foot{margin-top:1.25rem;font-size:.78rem;color:var(--muted);text-align:center}@media(max-width:480px){body{padding:1rem .5rem}.card{padding:1.25rem}}.grid2{display:grid;gap:1.1rem;grid-template-columns:1fr}@media(min-width:560px){.grid2{grid-template-columns:1fr 1fr}}.note{font-size:.82rem;color:var(--muted);border-left:3px solid var(--border);padding:.15rem 0 .15rem .7rem;margin:.2rem 0}.steps{display:flex;gap:.4rem;flex-wrap:wrap;list-style:none;padding:0;margin:0 0 1.1rem;font-size:.8rem}.steps li{border:1px solid var(--border);border-radius:999px;padding:.2rem .7rem;color:var(--muted)}.steps li[aria-current=step]{border-color:var(--accent);color:var(--accent-d);font-weight:700}.vh{position:absolute!important;width:1px;height:1px;margin:-1px;padding:0;overflow:hidden;clip:rect(0 0 0 0);white-space:nowrap;border:0}table.matrix{width:100%;border-collapse:collapse;font-size:.85rem}table.matrix th,table.matrix td{border:1px solid var(--border);padding:.4rem .5rem;text-align:left}table.matrix th{background:#eef1f5;font-weight:600}[data-branch]{display:none}[data-branch].on{display:grid}input:read-only,textarea:read-only{background:#f1f3f6;color:var(--muted)}input:disabled,select:disabled,textarea:disabled{background:#eceff3;color:#9aa3af}</style>
</head>
<body>
<main class="wrap"><div class="card">
<h1>Request a workplace adjustment</h1>
<p class="lead">An adjustment request that asks about needs, never about diagnoses. SAMPLE test data only.</p>
<form method="post" action="#" novalidate>
<div class="hp" aria-hidden="true"><label>Leave this field empty<input type="text" name="website" tabindex="-1" autocomplete="off"></label></div>
<fieldset><legend>Who is asking</legend>
<div class="field"><label for="f-requester">Your name <span class="req">*</span></label><input id="f-requester" type="text" name="requester" autocomplete="name" required></div>
<div class="field"><label for="f-team">Team</label><input id="f-team" type="text" name="team" autocomplete="organization"></div>
<div class="field"><label for="f-requester_email">Email <span class="req">*</span></label><input id="f-requester_email" type="email" name="requester_email" autocomplete="email" required></div>
</fieldset>
<fieldset><legend>What would help</legend>
<div class="group"><label class="opt" for="opt-adjustment-types-software"><input id="opt-adjustment-types-software" type="checkbox" name="adjustment_types" value="software" checked> Assistive software</label><label class="opt" for="opt-adjustment-types-hardware"><input id="opt-adjustment-types-hardware" type="checkbox" name="adjustment_types" value="hardware"> Different hardware</label><label class="opt" for="opt-adjustment-types-furniture"><input id="opt-adjustment-types-furniture" type="checkbox" name="adjustment_types" value="furniture"> Furniture or workspace changes</label><label class="opt" for="opt-adjustment-types-hours"><input id="opt-adjustment-types-hours" type="checkbox" name="adjustment_types" value="hours"> Adjusted hours</label><label class="opt" for="opt-adjustment-types-location"><input id="opt-adjustment-types-location" type="checkbox" name="adjustment_types" value="location"> Where I work</label><label class="opt" for="opt-adjustment-types-meetings"><input id="opt-adjustment-types-meetings" type="checkbox" name="adjustment_types" value="meetings"> How meetings run</label></div>
</fieldset>
<fieldset><legend>Detail</legend>
<div class="field"><label for="f-what_helps">Describe what would help <span class="req">*</span></label><textarea id="f-what_helps" name="what_helps" minlength="20" rows="4" required></textarea></div>
<div class="field"><label for="f-needed_from">Helpful from</label><input id="f-needed_from" type="date" name="needed_from" min="2026-08-01" value="2026-09-01"></div>
<div class="field"><label for="f-review_after">Review this after</label><select id="f-review_after" name="review_after"><option value="">Choose a period</option><option value="1m">One month</option><option value="3m" selected>Three months</option><option value="6m">Six months</option></select></div>
</fieldset>
<label class="opt" for="f-no_health_details"><input id="f-no_health_details" type="checkbox" name="no_health_details" value="yes" required> I understand this SAMPLE form asks for no health details</label>
<p class="hint" data-locked="notice">SAMPLE test data only - nothing is submitted, uploaded, or stored.</p>
<div class="ok" role="status">The sample request validated locally - nothing was sent.</div>
<div class="actions"><button type="submit" class="btn">Send the sample request</button></div>
</form>
<p class="foot">Free example form from Novus Examples · works offline, no data leaves your browser.</p>
</div></main>
<script>document.querySelectorAll('form').forEach(function(f){f.addEventListener('submit',function(e){e.preventDefault();var hp=f.querySelector('.hp input');if(hp&&hp.value){return;}if(!f.checkValidity()){f.reportValidity();return;}var ok=f.querySelector('.ok');if(ok){ok.style.display='block';ok.scrollIntoView({block:'nearest'});}f.reset();});});</script>
</body>
</html>
Specifications
- Fields
- 8
- Use Case
- accessibility-testing
- Validation
- HTML5 native
- Honeypot
- true
- Standalone
- true
- Dependencies
- none
- Health Data Collected
- false
- Adjustment Types
- 6
What is a .html file?
HTML (HyperText Markup Language) is the structural markup language of the web, using nested tags to define document content, semantics, and links. It is typically paired with CSS for presentation and JavaScript for behavior. It is the foundational format rendered by browsers.
How to use this file
Use an example HTML file to test parsers, DOM construction, sanitization of untrusted markup, and rendering or scraping pipelines.
How to use this file for testing
“Workplace Accommodation Request (HTML)” is a deterministic Novus Examples fixture for Form testing, Form parsing, HTML parsing, Web scraping. HTML and PDF form files for testing scrapers, autofill, validators, and PDF form fillers across real-life use cases.
Documented properties for this file: 8 fields. Compare results against paired or grouped companions on this page when present (clean↔damaged, searchable↔scanned, or format twins) so scores stay reproducible across runs.
Download the file once, keep the path stable in CI or local scripts, and treat the spec table as the contract: dimensions, seeds, field lists, and roles are intentional. Corrupt or invalid samples are labelled as such — expect parsers to fail loudly rather than silently accept them.
This form is fictional SAMPLE content for tooling tests (autofill, scrapers, PDF fillers). It is not an official government, bank, or clinic form. Open the HTML offline or fill the PDF in any viewer; the demo submit path never stores data.
Embed this form
It's a single self-contained HTML file (inlined CSS, native validation, no external requests). Download it, host it on your own site, and drop it into any page with an iframe.
iframe embed
<!-- Download accommodation-request.html, host it on your site, then embed the form anywhere: -->
<iframe
src="/path/to/accommodation-request.html"
title="Workplace Accommodation Request (HTML)"
width="100%"
height="640"
loading="lazy"
style="border:0">
</iframe>Related files
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