In the employment tribunals

Case no: [Insert case number]

Between:

[insert name of claimant]

Claimant

and

[insert name of respondent]

Respondent

_____________________________________________

CLAIMANT’S DISABILITY IMPACT STATEMENT

_____________________________________________

I [insert full name of witness] of [insert work or home address of witness] will say as follows:

Introduction

1. 1. 1

      I began working for the Respondent in [insert date]. My role [is OR was] [insert role].

   1. 2

      [I was dismissed on [insert date, eg 18 March 2021] for [insert reason, eg being late to work and absent from work on a number of occasions due my disability].]

   1. 3

      The disability I rely upon for the purposes of my claim is [insert details, eg ‘depression and anxiety’].

   Duration, diagnosis and medication

   1. 4

      [Insert details of the history of the impairment relied upon, eg ‘I first suffered from