Fillable OFFICE OF HUMAN RESOURCES Telework Program Telework Plan (Coppin State University)

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OFFICE OF HUMAN RESOURCES Telework Program Telework Plan (Coppin State University)

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1
OFFICE OF HUMAN RESOURCES
Telework Program
Telework Plan
Name ______________________________________________________ Empl. ID # _____________
Office Address _______________________________________________ Phone # ________________
Telework Address ____________________________________________ Phone # ________________
Supervisor __________________________________ Department_____________________________
Start Date of Telework _____________________ End Date of Telework ________________________
I. Summary of Telework Assignment
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
II. Assignments
The following are the agreed upon assignments to be worked on by the teleworker at the remote
location with the expected delivery dates:
Delivery Date
1)_______________________________________________________________ __________________
2)_______________________________________________________________ __________________
3)_______________________________________________________________ __________________
4)_______________________________________________________________ __________________
5)_______________________________________________________________ __________________
2
III. Work Schedule
Day
Work Hours
Location
Remote (R) - Campus (C)
Start
End
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Lunch
IV. Office Supplies
The teleworker agrees to obtain from the office all supplies needed for work at the telework
location. Out of pocket expenses for supplies regularly available at the department will not
normally be reimbursed.
_________________________________________________ _________________________
Employee Signature Date
_________________________________________________ _________________________
Supervisor Signature Date
OHR – Telework Program
Version 1.0 2020
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OFFICE OF HUMAN RESOURCES Telework Program Telework Plan (Coppin State University)

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Completed 29 January 2021

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