Remote Work Plan and Agreement Form



Remote Work Plan and Agreement FormThis document is intended to ensure that both the supervisor and the employee have a clear, shared understanding of the employee’s remote work arrangement. Each remote work arrangement is unique depending on the needs of the position, the supervisor, and the employee.Unless otherwise specified in this document, the employee or the employer may end a voluntary remote work arrangement at will. Employee Remote Work InformationEmployee:?? FORMTEXT ????????Job Title:?? FORMTEXT ??????Department:?? FORMTEXT ??????Supervisor:?? FORMTEXT ?????Type of remote work arrangement: FORMTEXT ?????Remote work arrangementeffective dates:Leave the end date blank if not applicable.??? FORMTEXT ??????? — ?? FORMTEXT ?????Job DutiesThe general expectation for a remote arrangement is that the employee will continue to effectively accomplish his or her regular job duties, regardless of work location. If there are remote work-specific job duties and/or expectations, specify them in the box below, or enter NA.Remote work-specific job duties and/or expectations:?? FORMTEXT ?????Work ScheduleRegular work schedule:Leave blank if all work is being done remotely.Work period for regular work days: FORMCHECKBOX Monday FORMCHECKBOX Tuesday FORMCHECKBOX Wednesday FORMCHECKBOX Thursday FORMCHECKBOX FridayFrom FORMTEXT ???????? To FORMTEXT ?????Remote work schedule:Check days that apply.Work Period for remote work days: FORMCHECKBOX Monday FORMCHECKBOX Tuesday FORMCHECKBOX Wednesday FORMCHECKBOX Thursday FORMCHECKBOX FridayFrom ? FORMTEXT ????????? To ????? FORMTEXT ?????Remote Work Arrangement ModificationIf either the employee or the supervisor needs to modify or end the remote work arrangement, record how that change will be communicated and how much advance notice will be required. An email or phone call may be sufficient for short-term or unexpected schedule changes. However, some jobs may require more notice. Specify any details about changes to the arrangement. All employee-proposed changes are subject to departmental approval.How to make changes to the arrangement:????? FORMTEXT ?????Remote Work Review Specify a date to meet and discuss the effectiveness of the remote work arrangement. Note that earlier or more frequent remote work plan reviews may be initiated by the manager when warranted.Initial remote work plan review date (not to exceed 60 days):??? FORMTEXT ?????Ongoing remote work plan review date (annually at a minimum):??? FORMTEXT ??????Additional detailsAdd any other information applicable to this arrangement:???? FORMTEXT ?????My signature below acknowledges receipt of, and full agreement with, the terms of this Remote Work Plan and Agreement. In addition, I attest to holding current insurance for both liability and equipment. Employee signature: __________________________________________________________, date: ____________________________Supervisor signature: __________________________________________________________, date: ____________________________Human Resources signature: __________________________________________________, date: ____________________________ ................
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