DPA Telework Policy

Checklists and Agreement

Before Starting Telework

These procedures are to be followed prior to the start of a telework schedule:

1. The employee submits a written request to his/her immediate supervisor, who should discuss the proposal with his/her division chief. If the proposal is viewed as having potential for approval, the following steps should be followed.
2. A "Safety Checklist" is completed, signed and dated by the employee and submitted to the supervisor/manager for approval and signature.
3. Supervisor completes the Supervisor's Checklist. The employee and supervisor sign and date the bottom of the form. The supervisor retains the signed form.
4. Supervisor or the employee completes the Telework Agreement and Telework Assignment Log. The agreements are signed and dated by the teleworker, supervisor and division chief, with the division chief having final decision making responsibility for approval of the Telework agreement. The manager/supervisor retains the original signed form.

Within two weeks of starting the telework schedule:

1. All teleworkers who use a computer off-site must complete the "Workstation Checklist" contained in the Computer User's Guide to an Ergonomic Workstation - PDF published by the DPA Benefits Division.
2. The Workstation Checklist is submitted by the employee to his/her supervisor or manager for review. The supervisor or manager will then sign and date the checklist below the employee name and sends to the employee's division chief for retention with the teleworker's file.

Here are the forms:

Safety Checklist

The following checklist must be completed prior to the beginning of home teleworking.

Fire Protection Household

• Smoke Alarm/Detector (UL Approved)
• Fire Extinguisher (UL Approved)
• Easy access to fire extinguisher

Household

• Computer User's Handbook reviewed
• Workstation checklist will be completed by (date):
• Uncluttered work environment

Home office safety re-certification will be required on an annual basis.

I certify that my home office meets all the above requirements.

Employee Signature and Date:

Supervisor:

• Approved
• Denied (Provide reason)

Supervisor Signature and Date:

Supervisor's Checklist

Name of Employee:

Name of Supervisor:

The following tasks must be completed prior to the start of the telework arrangement.

• Employee and Supervisor have read and agree to abide by the provisions of the DPA Telework Policy and Procedures.
• Performance expectations have been discussed and are clearly understood.
• Appropriate training has been arranged for, completed, and skill levels evaluated.
• The employee is familiar with requirements pertaining to the security and confidentiality of data and information.
• Phone contact procedures have been clearly defined.

• Citrix Access Request form (DPA 870) must be completed, signed by employee and division chief and submitted to IMS for approval and authorization.

Other items discussed:

Employee's Signature and Date:

Supervisor's Signature and Date:

Telework Agreement

Name of Teleworker:

Residence Address:

Residence Phone:

Mobile Phone (if applicable):

Understanding

The division chief, supervisor and the teleworker have read and understand the DPA Telework Policy and Procedures. All parties understand that the Telework agreement may be terminated by the division chief or the teleworker as indicated in this policy and associated procedures. The supervisor and the teleworker have read, understand, completed, and signed the "Supervisor's Checklist," prior to participation in the telework program and further agree to the following:

Telework Schedule

It is understood that telework days must be scheduled in advance and approved by the supervisor. At certain times, it may be necessary for the telework schedule to be revised to ensure critical deadlines are met or to attend meetings. Any change by the teleworker in the agreed upon schedule must be pre-approved, and when permanent, documented and appended to the Telework Agreement.

The following telework schedule is being established:

• Regular
• Casual
• Full-time

Date of first scheduled telework day:

Telework days and hours will typically be:

Teleworker will be available for communication on telework days during the hours of:

Begin Time:

to

End Time:

This arrangement must be reviewed and renewed at least annually to ensure the standards for participation are being followed.

Information Security

The teleworker will provide necessary security for both electronic and paper information.

Work Effectiveness and Safety

The teleworker agrees to:

• Master computer hardware and software skills necessary to perform the assigned telework duties.
• Learn and apply ergonomic safety practices.
• Establish and maintain a safe home office environment.
• Ensure customer needs take precedence over the home office schedule.
• Proactively stay in touch with customers.
• Ensure the work takes precedence over family and home matters during home office hours.
• Make arrangements for dependent care, if applicable.
• Produce electronic work products that are usable in DPA's automated system with no additional work.

Teleworker

• Signature:
• Date:

Supervisor

• Signature:
• Date:

Division Chief

• Signature:
• Date:

Telework Assignment Log

Week of:

Employee Name:

Division:

Telework Schedule:

Supervisor Name:

Task(s) Assigned	Estimated Hours
Total Estimated Hours

 

Task(s) Assigned	Actual Hours
Total Actual Hours

Comments:

Employee

• Signature:
• Date:

Supervisor

• Signature:
• Date:

Updated July 28, 2009 at 10:24 AM.