Sample Telework Policy and Agreement

United States Office of Personnel Management
"Balancing Work and Family Demands Through Telecommuting"

Sample Agreement
Between Agency and Employee Approved for Telecommuting on a Continuing Basis
The supervisor and the employee should each keep a copy of the agreement for reference.

Voluntary Participation

Employee voluntarily agrees to work at the agency-approved alternative workplace indicated below and to follow all applicable policies and procedures. Employee recognizes that the telecommuting arrangement is not an employee benefit, but an additional method the agency may approve to accomplish work.

Trial Period

Employee and agency agree to try out the arrangement for at least [specify number] months unless unforeseeable difficulties require earlier cancellation.

Salary and Benefits

Agency agrees that a telecommuting arrangement is not a basis for changing the employee's salary or benefits

Duty Station and Alternative Workplace

Agency and employee agree that the employee's official duty station is [indicate duty station for regular office] and that the employee's approved alternative workplace is: [specify street and number, city, and state].

Note: All pay, leave, and travel entitlements are based on official duty station.

Official Duties

Unless otherwise instructed, employee agrees to perform official duties only at the regular office or agency-approved alternative workplace. Employee agrees not to conduct personal business while in official duty status at the alternative workplace, for example, caring for dependents or making home repairs.

Work Schedule and Tour of Duty

Agency and employees agree that employee's official tour of duty will be: [specify days, hours, and location, [i.e., the regular office or the alternative workplace].

Time and Attendance

Agency agrees to make sure the telecommuting employee's timekeeper has a copy of the employee's work schedule. The supervisor agrees to certify biweekly the time and attendance for hours worked at the regular office and the alternative workplace. (Note: Agency may require employee to complete self-certification form.)

Leave

Employee agrees to follow established office procedures for requesting and obtaining approval of leave.

Overtime

Employee agrees to work overtime only when ordered and approved by the supervisor in advance and understands that working overtime without such approval may result in termination of the telecommuting privilege and/or other appropriate action.

Equipment/Supplies

Employee agrees to protect Government-owned equipment and to use the equipment only for official purposes. The agency agrees to install, service, and maintain any Government-owned equipment issued to the telecommuting employee. The employee agrees to install, service, and maintain any personal equipment used. The agency agrees to provide the employee with all necessary office supplies and also reimburse the employee for business-related long distance telephone calls.

Security

If the Government provides computer equipment for the alternative workplace, employee agrees to the following security provision: [insert agency-specific language].

Liability

The employee understands that the Government will not be liable for damages to an employee's personal or real property while the employee is working at the approved alternative workplace, except to the extent the government is held liable by the Federal Tort Claims Act or the Military Personnel Civilian Employees Claims Act.

Work Area

The employee agrees to provide a work area adequate for performance of official duties.

Worksite Inspection

The employee agrees to permit the Government to inspect the alternative workplace during the employee's normal working hours to ensure proper maintenance of Government-owned property and conformance with safety standards. (Agencies may require employees to complete a self-certification safety checklist.)

Alternative Workplace Costs

The employee understands that the Government will not be responsible for any operating costs that are associated with the employee's using his or her home as an alternative worksite, for example, home maintenance, insurance, or utilities. The employee understands he or she does not relinquish any entitlement to reimbursement for authorized expenses incurred while conducting business for the Government, as provided for by statute and regulation.

Injury Compensation

The employee understands he or she is covered under the Federal Employee's Compensation Act if injured in the course of actually performing official duties at the regular office or the alternative duties station. The employee agrees to notify the supervisor immediately of any accident or injury that occurs at the alternative workplace and to complete any required forms. The supervisor agrees to investigate such a report immediately.

Work Assignment/Performance

Employee agrees to complete all assigned work according to procedures mutually agreed upon by the employee and the supervisor and according to the guidelines and standards in the employee performance plan. The employee agrees to provide regular reports if required by the supervisor to help judge performance. The employee understands that a decline in performance may be grounds for cancelling the alternative workplace arrangement.

Disclosure

Employee agrees to protect Government/agency records from unauthorized disclosure or damage and will comply with requirements of the Privacy Act of 1974, 5 U.S.C. 552a.

Standards of Conduct

Employee agrees he or she is bound by agency standards of conduct while working at the alternative worksite.

Cancellation

Agency agrees to let employee resume his or her regular schedule at the regular office after notice to the supervisor. Employee understands that the agency will cancel the telecommuting arrangement and then instruct the employee to resume working at the regular office. The agency agrees to follow any applicable administrative or negotiated procedures.

Other Action

Nothing in this agreement precludes the agency from taking any appropriate disciplinary or adverse action against an employee who fails to comply with the provisions of the agreement.

Employee's Signature and Date:

Supervisor's Signature and Date:

Sample Self-certification Safety Checklist for
Home-based Telecommuters

The following checklist is designed to assess the overall safety of your alternate duty station. Please read and complete the self-certification safety checklist. Upon completion, you and your supervisor should sign and date the checklist in the spaces provided.

The alternate duty station is:

Describe the designated work area in the alternate duty station:

A. Workplace Environment

1. Are temperature, noise, ventilation and lighting levels adequate for maintaining your normal level of job performance?................................................................Yes [ ] No [ ]

2. Are all stairs with four or more steps equipped with handrails?...................Yes [ ] No [ ]

3. Are all circuit breakers and/or fuses in the electrical panel labeled as to intended services?....................................................................................................Yes [ ] No [ ]

4. Do circuit breakers clearly indicate if they are in the open or closed position?......Yes [ ] No [ ]

5. Is all electrical equipment free of recognized hazards that would cause physical harm (frayed wires, bare conductors, loose wires, flexible wires running through walls, exposed wires to the ceiling)?..................................................................................Yes [ ] No [ ]

6. Will the building's electrical system permit the grounding of electrical equipment?................................................................................................Yes [ ] No [ ]

7. Are aisles, doorways, and corners free of obstructions to permit visibility and movement?................................................................................................Yes [ ] No [ ]

8. Are file cabinets and storage closets arranged so drawers and doors do not open in walkways?.................................................................................................Yes [ ] No [ ]

9. Do chairs have any loose casters (wheels) and are the rungs and legs of the chairs sturdy?.......................................................................................................Yes [ ] No [ ]

10. Are the phone lines, electrical cords, and extension wires secured under a desk or alongside a baseboard?...............................................................................Yes [ ] No [ ]

11. Is the office space neat, clean and free of excessive amounts of combustibles?.....Yes [ ] No [ ]

12. Are floor surfaces clean, dry, level, and free of worn or frayed seams?....Yes [ ] No [ ]

13. Are carpets well secured to the floor and free of frayed or worn seams?...Yes [ ] No [ ]

14. Is there enough light for reading?...............................................................Yes [ ] No [ ]

B. Computer Workstation (if applicable)

15. Is your chair adjustable?.............................................................................Yes [ ] No [ ]

16. Do you know how to adjust your chair?.....................................................Yes [ ] No [ ]

17. Is your back adequately supported by a backrest?.......................................Yes [ ] No [ ]

18. Are your feet on the floor or fully supported by a footrest?.........................Yes [ ] No [ ]

19. Are you satisfied with the placement of your monitor and keyboard?..........Yes [ ] No [ ]

20. Is it easy to read the text on your screen?...................................................Yes [ ] No [ ]

21. Do you need a document holder?...............................................................Yes [ ] No [ ]

22. Do you have enough legroom at your desk?...............................................Yes [ ] No [ ]

23. Is the screen free from noticeable glare?....................................................Yes [ ] No [ ]

24. Is the top of the screen at eye level?...............................................................Yes [ ] No [ ]

25. Is there space to rest the arms while not keying?........................................Yes [ ] No [ ]

26. When keying, are your forearms parallel with the floor?...............................Yes [ ] No [ ]

27. Are your wrists fairly straight when keying?...............................................Yes [ ] No [ ]

Employee's Signature/Date:

Immediate Supervisor's Signature/Date:

Approved[ ] Disapproved [ ]

Please return a copy of this form to your flexiplace coordinator.

*This checklist was developed by the United States General Services Administration.

Posted August 1997