Fillable COVID-19 Short-term Remote Work Form (Ferris State University)

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COVID-19 Short-term Remote Work Form (Ferris State University)

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Ferris State University
Human Resources Office (231)591-2150
420 Oak Street, Prakken 150 Fax (231)591-2978
Big Rapids, MI Email hr@ferris.edu
* Please note that prior to approval of a remote option, the employee and the supervisor must agree on the
terms of the Remote Work. Once the form is approved the signed document must be sent to Human
Resources for the personnel file.
COVID-19 Short-term Remote Work Form
Staff Eligible for Short Term Remote Work:
• Individuals in office locations that the decision has been made as part of the Office Safety Plan that
remote work will be in place.
• Individuals at higher risk have been identified as by the CDC -
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html
• Individuals granted a reasonable accommodation pursuant to the American’s With Disabilities Act
• Others as approved by Human Resources.
Staff Not Eligible for Short-Term Remote Work:
AFSCME staff, Birkam Nurses, Police, Sergeants, Dispatchers
Employee Information
Name:
Job Title: Department:
Remote Work Location
Designated location of remote worksite
The employee agrees to work at the designated site during the hours specified in the agreement
as defined below. Any change of location must be approved in advance by the supervisor.
Requested Terms of Remote Work Agreement
Start Date: Anticipated End Date:
Work hours are specified below. Any change must be approved in advance by the supervisor.
Days and times employee
will be remote
Non-exempt employee
mealtimes
# of Work Hours
Monday
to
to
Tuesday
to
to
Wednesday
to
to
Thursday
to
to
Friday
to
to
Saturday
to
to
Sunday
to
to
Non-exempt employees are subject to FLSA regulations. Any hours worked over 40 in a workweek
must be authorized in advance by the supervisor and the employee must be paid overtime. The
supervisor will maintain a record of actual hours worked. Non-exempt employees working 8 hours
in a row should have a defined meal period. Employees are expected to utilize Time Clock Plus to
document their hours per their normal protocol.
The remote employee may or may not be expected to attend meetings, training sessions or
similar events on campus as required by the supervisor.
Schedule of Standing Meetings
Meeting Day
Time
Title/Purpose
Frequency
Attendance
Employees must obtain supervisor approval before taking any leave in accordance with established
procedures.
Employee Responsibilities and Obligations
• All job responsibilities and conditions of employment apply as if the employee were working at the
primary worksite.
• Employees will comply with all University rules, policies and procedures that would be in effect if the
employee were working at the primary worksite. Employees must notify their supervisor immediately
of any situation that interferes with their ability to perform their jobs.
• Complete the daily symptom checker as required by OSHA.
• Work developed or produced during remote work away from the primary worksite remains the
property of Ferris State University.
• A remote arrangement is not a substitute for child/dependent care. Employees are required to make
child/dependent care arrangements during the agreed-upon work hours. Supervisors may ask the
employee to provide child/dependent care information.
• Employees must certify that the remote work environment is safe and the same safety habits that
would be used at an on-campus site are being practiced (see attached checklist).
• Remote employees are encouraged to contact their insurance agent for any information regarding
home worksites and coverage for equipment that is damaged, destroyed, or stolen.
• An employee who is in a remote agreement is not entitled to reimbursement for travel mileage to
attend work meetings.
• Tax deductions (i.e. home office deductions) are not applicable if the remote arrangement is for the
convenience of the employee. The employee should seek professional advice for any questions or
concerns regarding tax issues.
• Failure to follow policies, procedures, and practices may result in termination of the
arrangement and/or disciplinary action.
Work Details
Employee Telephone Number:
(where employee can be reached during remote hours)
Employee Email Address:
(email address from which employee will be working)
Supervisors and employees should review the following prior to entering into a remote agreement:
How calls received for employee during time out of the department office will be handled.
How will work assignments be performed at the remote worksite.
How job performance standards are to be maintained.
How the employee’s performance will be assessed and the frequency of assessment.
How the employee and supervisor will communicate.
How communication with others at the University will be handled.
If University-owned equipment fails at the remote site, how will down time will be handled.
Describe records/files the employee is allowed to keep at the remote site. Be sure to also
describe measures that will be in place to maintain security of documents/data.
Remote Resources Checklist
Equipment/Furniture/Supplies
Provided by
Employee
Provided by
Ferris State
Insured by
Employee
Insured by
Ferris State
Cell phone
N/A
N/A
Cell phone options (email, internet
access, etc.)
N/A
N/A
Internet
N/A
N/A
N/A
Laptop
Desktop
Other: please describe:
Applicable Terms
Workers’ Compensation
The remote employee is covered by workers’ compensation for an injury or illness resulting from
performing official duties at the designated site. The employee must authorize access to appropriate
officials at the remote site to perform safety inspections and/or investigate a workers’ compensation
claim.
Property and Equipment
Home worksite equipment shall generally be provided by the employee. In the event that equipment
is provided by Ferris State, such equipment shall be used by the employee exclusively for Ferris State
business.
The employee agrees to take reasonable steps to protect any University property from theft, damage,
or misuse. This includes maintaining data security and record confidentiality. The employee will
comply with all copyrights and licensing agreements for all software owned by the University.
Depending on the circumstances, the employee may be responsible for any damage of, or loss of,
University property based on the discretion of the University.
The employee is responsible for maintenance and repair of these items unless other arrangements
have been made in advance and in writing with the supervisor/manager’s approval. The University
assumes no responsibility for any damage to, depreciation of, or loss of the employee’s personal
property that may be used at home (or another remote worksite) for Ferris State business. Ferris State
may pursue recovery from the remote employee for University property that is deliberately or through
negligence damaged or destroyed while in the employee’s care.
The employee will return University equipment, records, and materials, upon request and/or
termination of the remote work agreement. The employee may be responsible for any costs necessary
to return, repair, or replace University property. If University property is not returned upon request, at
the end of a remote work situation or upon termination, the employee (or former employee) is
responsible for all costs to replace any unreturned equipment.
If the employee is unable to meet work obligations due to equipment issues, the employee will notify
their supervisor and may be required to travel to the workplace to perform their job functions until the
issues are resolved or take time off from work. The employee agrees to report to their
supervisor/manager instances of loss or damage to University property or known unauthorized use
or access to University systems or data.
Property Insurance
The University has an insurance program to insure its property wherever it is approved for use.
In the case of any damaged or lost equipment, the Purchasing Office must be contacted as soon as
possible for assistance in filing a claim. The University is not liable for personal property.
Data Security
Employees may find the need to take University confidential information off-site to remote location in
either paper or electronic form. In order to ensure the security and confidentiality of sensitive
information, employees must take appropriate safeguards to protect the integrity of data and prevent
unauthorized disclosure such as by not sharing passwords with others or implementing screensavers.
External computers that are used to administer University resources or access sensitive information
must be properly configured and secured. Employees are required to connect to the University’s
network through the Virtual Private Network (VPN), have personal firewall software installed, and be
running current virus protection software.
When accessing sensitive data remotely, it is prohibited to store sensitive data (such as Social
Security Numbers, student records, credit card numbers) onto local hard drives, floppy disks, or other
external media (including laptops and smartphones). Employees should only save files to a server
that is maintained by the University.
All employees must follow all University policies and procedures relating to the security and
integrity of sensitive data.
The remote employee will protect University information from unauthorized disclosure or damage and
will comply with federal, state and university rules, policies and procedures regarding disclosure of
public and official records. Work done at the employee’s remote site is regarded as official University
business. All records, documents and correspondence, either in paper or electronic form must be
safeguarded for return to the University. Release or destruction of records should be done only in
accordance with University policy and procedure and with the knowledge of the employee’s
supervisor. Electronic/computer files are considered University records and shall be protected as
such.
The employee will ensure compliance with FERPA, HIPAA and other policies/regulations associated
with confidentiality and security of information. If the employee is unfamiliar with the requirements of
these or other regulations regarding security of information, they will notify their supervisor for further
assistance.
University Records and Files
All University records and files temporarily stored at a remote location remain the property of Ferris
State products, documents and records that are used, developed or revised must be copied and/or
returned to the University when requested, at the end of the remote agreement and/or at the
termination of employment. The employee will protect all confidential University documents from
unauthorized access.
Personal Property Liability
The University will not be liable for damages to the remote employee’s property resulting from the
remote agreement.
Termination of Agreement
By signing this agreement, I state that I have read and understand the remote guidelines and
remote conditions and agree to the terms and conditions set forth by this agreement. I believe
that my work can be completed within the above schedule and location with no loss of service or
disruption to others in my department, the University, or external customers. I understand that it
is my responsibility to make my remote arrangement a success. A supervisor or other staff
member may terminate or modify the arrangement at any time at the discretion of the University.
I certify that my remote work environment is safe and the same safety habits that would be used
at an on-campus site are being practiced (see attached checklist).
I agree with the conditions for use of Ferris State University equipment, and/or data, and the
nature of the equipment, to be provided for or paid for by the department as outlined in this
agreement.
Employee S
ignature Date
Employee Name (printed/typed)
Supervisor
Signature
Date
Supervisor Name (
printed/typed)
V
ice President Signature
Date
Vi
ce President Name (printed/typed)
See attached Office Ergonomics Check List
HUMAN RESOURCES PROCESS:
HR Signature:
_____
___________________________________
Date of Receipt: __________________
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COVID-19 Short-term Remote Work Form (Ferris State University)

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Completed 29 January 2021

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