Fillable Telecommuting Assessment And Agreement For COVID-19 TELECOMMUTING AGREEMENT

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Telecommuting Assessment And Agreement For COVID-19 TELECOMMUTING AGREEMENT

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Before an employee completes a Telecommuting Agreement, the employee and supervisor must complete
a Telecommuting Agreement and Assessment for COVID-19.
Work hours, compensation, benefits, use of sick time off, and approval for use of annual time off will
continue to conform to university policies and procedures. All Telecommuting Agreements begin with a
90-day trial period, and during or after that period, they may be discontinued by the department and/or
the university at any time for any reason. This Telecommuting Agreement does not alter the at-will nature
of employment.
A. Employee Information
Name: ________________________________________ GWid: ______________________
Job Title: _________________________ Grade: _______ FLSA Status: Exempt
Non-exempt
Department: ___________________________________
Direct Supervisor: _______________________________ Telephone: ____________________
Department Head: ______________________________ Telephone: ____________________
B. Telecommuting Work Site
Street Address: ________________________________________________________________
City: _________________________ State: ______ Zip: ______________
Work Phone: ____________________ Email: _______________________
Cell Phone: ______________________ Fax: _________________________
Description of specific workspace and location (ex. is the workspace at a home or a commercial site?):
Telecommuting Agreement and Assessment for
COVID-19
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C. Work Schedule and Hours
Telecommuting Work Schedule
Begin Date: __________________ End Date: ___________________
Provide regular telecommuting work hours agreed to:
Monday: __________ to __________ Friday: __________ to __________
Tuesday: __________ to __________ Saturday: __________ to __________
Wednesday: __________ to __________ Sunday: __________ to __________
Thursday: __________ to __________
A non-exempt employee’s work day schedule must incorporate a 30 minute, 45 minute, or one
hour bona fide meal period. A non-exempt employee must be completely free from work
responsibilities during the meal period. If the employee is non-exempt, please provide the length
of the bona fide meal period here: ________________________. It is expected that exempt
employees will follow departmental guidelines regarding meal periods.
Describe any variation from the regular work hours documented above:
The telecommuting employee must be able to be present at his/her office/department as
necessary to attend meetings, training sessions, or similar events or occurrences.
Non-exempt employees are paid on an hourly basis for all work performed. Any hours worked
over forty (40) in a workweek (Sunday 12:00 AM through Saturday 11:59 PM) must be authorized
in advance by the supervisor and must be paid at 1.5 times the employee’s regular hourly rate.
Supervisors must maintain a record of actual hours worked.
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The university’s Worker’s Compensation program provides coverage for injuries and illnesses
incurred in the course and scope of employment. “Course and scope of employment” is limited to
the hours and location described in this Telecommuting Agreement.
D. Equipment
University property that will be utilized at the
telecommuting location:
Employee-owned equipment that will be
utilized at the telecommuting location:
With reasonable notice, the university may make on-site visits to the telecommuting location to
determine if the work site is safe and free from hazards, and to maintain, repair, inspect or retrieve
university-owned equipment, software, data and supplies.
Upon the termination of the Telecommuting Arrangement, the employee must return university
equipment in the same condition in which it was originally received, minus normal wear and tear.
The employee is personally responsible for missing or damaged equipment.
E. Work Plan
The purpose of this section is to demonstrate how the employee will continue to meet the
responsibilities of his/her position when working away from the office.
Responsibilities and Objectives
The employee shall provide details on his/her major areas of responsibility, tasks, and measurable
objectives, taking into consideration annual goals and other priorities. Be particularly specific
about what must be accomplished. The employee should also consider how he/she will overcome
any barriers or modify current processes in order to work effectively in a virtual environment.
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Communication Plan
The employee shall provide details on communication with his/her supervisor and others while
telecommuting. How often will the employee meet with his/her supervisor and team? How will
these meetings take place? This could include scheduling in-person meetings or using phone or
video conferencing tools to meet virtually. Also the employee should note ways in which GW
colleagues, customers, etc., will be able to reach the employee, such as by phone, instant
messenger, video conferencing, email, etc.
F. Work Review Periods
Describe specifically below in what manner the supervisor and employee agree to review
completed work and/or discuss work status on an ongoing basis (ex. weekly 1-on-1 by phone,
monthly in-person goal check-ins).
G. Tax and Legal Implications
Tax or other legal implications for the business use of the employee’s home will be based on IRS
and state and local government restrictions, or the laws of the jurisdiction in which employee’s
telecommuting site is located during the period of the Telecommuting Agreement. Responsibility
for fulfilling obligations in this area rests solely with the employee.
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H. Termination of the Telecommuting Agreement
This Telecommuting Agreement may be terminated by the university at any time. Although
efforts will be made to provide reasonable notice of termination to accommodate personal
commitments, such as childcare and commuting requirements, there may be instances when
notice is not possible. Requests to terminate this Telecommuting Agreement by the employee
will be considered by the supervisor.
Employee:
I agree to this Telecommuting Agreement. In addition, I have reviewed all GW policies pertinent
to telecommuting, including those related to the security of GW data, systems, and equipment.
Name: ________________________________________
Signature: ________________________________________ Date:____________________
Supervisor:
I have reviewed and approved this Telecommuting Agreement.
Name: ________________________________________
Signature: ________________________________________ Date:____________________
Assistant Vice President, Associate Vice Provost, or Vice President:
I have reviewed and approved this Telecommuting Agreement.
Name: ________________________________________
Signature: _________________________________________ Date:____________________
After approval, the signed Telecommuting Agreement, should be forwarded to Human Resource
Management and Development for review and approval.
Reviewed by Human Resource Management and Development:
I have reviewed and approved this Telecommuting Agreement.
Name: ________________________________________
Title: ________________________________________
Signature: ________________________________________ Date:____________________
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Telecommuting Assessment And Agreement For COVID-19 TELECOMMUTING AGREEMENT

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Completed 29 March 2020

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