Fillable Telework Application (Edmonds Community College)

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Telework Application (Edmonds Community College)

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Teleworking General Information
REV. 09/12 | 10-11-090 J
Teleworking is a voluntary, alternative work arrangement available for Edmonds Community College employees. This
usually means working at home from 1-3 times a week on an on-going basis. Teleworking can also be more informal,
such as periodically working from home for a short-term project or on the road during business travel. Other informal,
short-term arrangements may be made for employees on family or medical leave, to the extent possible for the
employee and the College, and with the consent of the employee’s health care provider, if appropriate.
Teleworking does not change the basic terms, expectations, and conditions of employment with the College. It is
a work alternative, rather than a reward, and is intended to enhance productivity, creativity, employee satisfaction
and/or reduce operating costs. The Designated Alternative Worksite Agreement may not be permanent and may be
modied or terminated if it is determined that the College and/or employee needs are not being met. All teleworking
arrangements are made on a case-by case-basis, focusing on the business needs of the College’s operations and the
College’s mission and goals.
Telework Feasibility Review
Employee and supervisor should work through the following assessment before approving a telework plan.
Eligibility Criteria
• Must be a permanent employee of the College
• Must have successfully completed probationary period (unless a waiver has been secured)
• Must be approved on a case-by-case basis depending upon job function, customer service, supervisory duties,
and other job related considerations.
Work Product Assessment
Use the current job description and performance criteria in completing this part of the assessment.
Evaluating/monitoring work product
• Is there an adequate method of evaluating productivity?
• Can tasks be clearly dened?
• Can clear objectives be set?
• Can specic time frames be established?
• How will the work be measured?
• Employees must be able to account for work done while teleworking. Supervisors are encouraged to have
employees use the Telework Log that is available on the HR website for this purpose. The log is not required
by HR, but is a resource for supervisors and employees to measure work.
Job Duties and Responsibilities
• Which aspects of the employee’s work are unpredictable and need immediate attention?
• How will these situations be handled when the employee is teleworking?
In Person Contact
• What amount of face-to-face communication is needed to perform assignments?
• What is the impact of the employee’s not being available for in-person communication with clients and co-
workers?
Communication
• What impact, if any, will teleworking have on timely communication with clients?
• What impact, if any, will teleworking have on timely communication between employee and other sta?
Teleworking General Information
Impact on Work Unit
What, if any, oce activities need to be reorganized in order to facilitate the teleworking arrangement?
• Duties of other sta
• Workow (mail, phone, and email messages)
• Meetings
Telework Schedule
Based on the above analysis, what is a reasonable amount of time for teleworking?
Considerations
• Length of commitment — temporary or long term
• Number of days/week
• Days of week that would be least disruptive to organization
• Variability of schedule
Resource Needs Assessment for Home or Alternate Worksite
Worksite
Use the Designated Alternative Worksite Checklist to complete this part of the assessment.
Next Steps:
• Complete the Designated Alternative Worksite Checklist
• Complete Teleworking Application
• Complete Worksite Agreement
• Develop a plan for implementing any modication of internal operations or procedures that need to be in place
prior to initiating the teleworking assignment
• Forward to Human Resources for review and approval
REV. 09/12 | 10-11-090 J
Teleworking Application
LAST NAME FIRST NAME
PHONE NUMBER
TELEWORK REQUEST INITIATED BY EMPLOYEE SUPERVISOR
TYPE OF TELEWORK REQUESTED (CHECK ONE) ONGOING PERIODIC DISABILITY/FMLA
PROPOSED START DATE
PROPOSED TELEWORKING SCHEDULE
REV. 09/12 | 10-11-090 J
IN OFFICE REGULAR FLEXIBLE
DAYS MON TUE WED THU FRI
SCHEDULE ______ ______ ______ ______ ______
AT ALTERNATIVE SITE REGULAR FLEXIBLE
DAYS MON TUE WED THU FRI
SCHEDULE ______ ______ ______ ______ ______
SUPERVISOR SIGNATURE DATE
APPROVED DISAPPROVED APPROVED WITH THE FOLLOWING RECOMMENDATIONS
HUMAN RESOURCES SIGNATURE DATE
APPROVED DISAPPROVED APPROVED WITH THE FOLLOWING RECOMMENDATIONS
CORE HOURS
DESCRIBE THE TYPE OF WORK YOU PROPOSE TO DO AT HOME
RETURN COMPLETED FORM TO HUMAN RESOURCES
Designated Alternative Worksite Agreement
REV. 09/12 | 10-11-090 J
LAST NAME FIRST NAME
THIS AGREEMENT is entered into by and between the above named employee, an employee of Edmonds Community
College (“Employee”), and Edmonds Community College District 23, an agency of the State of Washington (“College”),
whose principal place of business is 20000 68th Avenue West, Lynnwood, Washington 98036-5999.
A. Voluntary Participation
The Employee has successfully completed the probationary period (or a waiver of that requirement has been
approved) and voluntarily agrees to work at the College-approved Designated Alternative Worksite (“Alternative
Site”), dened below in Section D, and to follow all applicable policies and procedures. The Employee recognizes that
the teleworking arrangement is not an employee entitlement but an additional method the College may approve to
accomplish the College’s work.
B. Trial Period
Employee and College agree that the supervisor will evaluate, in writing, the eectiveness of the arrangement during
an initial three (3) month trial period before continuing the arrangement.
C. Job Responsibilities
The Employee and College agree that a teleworking arrangement is not a basis for changing the employee’s basic
terms, expectations and conditions of employment including but not limited to salary and benets.
D. Duty Station and Designated Alternative Worksite
College and the Employee agree that the Employee’s ocial duty station is specied as indicate duty station for
regular oce and that the Employee’s approved Alternative Site is to specify street and number, city, and state.
E. Work Area
The employee agrees to provide and maintain a work area adequate for performance of ocial duties as
demonstrated by an approved Worksite Checklist.
F. Alternative Worksite Inspection
The employee agrees to permit the college to inspect the Alternative Site with a minimum of 24 hours notice during
the Employee’s normal working hours to ensure a safe and healthful work environment.
G. Alternative Site Costs
The Employee understands that the College will not be responsible for any operating costs associated with the
employee using his or her home as an Alternative Site; for example, home maintenance, insurance, or utilities
expenses. The Employee understands he or she does not relinquish any entitlement to reimbursement for authorized
expenses incurred while conducting business for the College, as provided for by statute and regulations.
H. Ocial Duties
Unless otherwise instructed, the Employee agrees to perform ocial duties only at the regular oce or College-
approved Alternative Site. The Employee agrees not to conduct personal business during agreed core hours at the
Alternative Site, such as caring for dependents, performing household duties, or making home repairs.
Designated Alternative Worksite Agreement
I. Work Schedule
College and the Employee agree the Employee’s ocial work schedule will be as specied in the Teleworking
Application. Changes to the schedule will be approved by the supervisor and a superceding form forwarded to the
Human Resources Oce. The Employee acknowledges that there may be times when the Employee will be requested
to come into the oce on teleworking days when the nature of the work department’s workload requires it. It is the
Employee’s responsibility to come into the oce as requested during these times.
J. Time and Attendance
The College agrees to ensure a copy of the Employee’s work schedule is placed in the Employee’s personnel le.
K. Leave
The Employee agrees to follow established oce procedures for requesting and obtaining approval of leave. The
College’s normal leave policies will apply to the Employee’s work hours completed both at the regular Duty Station
and the Alternative Site.
L. Overtime
Unless exempt from the overtime requirements of the Fair Labor Standards Act, The Employee agrees to work
overtime only with advance approval by the supervisor. The Employee understands that overtime work without such
approval is not compensated and may result in termination of the teleworking privilege and/or other appropriate
action. If approved, overtime is to be documented in writing and submitted according to current College regulations.
M. Work Assignments/Performance
The Employee agrees to complete all assigned work according to procedures mutually agreed upon by the Employee
and the supervisor and according to the guidelines and standards specied in the Employee’s performance plan. The
Employee agrees to provide regular reports if required by the supervisor to help judge performance. The Employee
understands that a decline in performance may be grounds for canceling the teleworking arrangement.
N. Equipment/Supplies
The Employee agrees to protect any College-owned equipment and to use the equipment only for ocial purposes.
Use of such equipment by household members or anyone else is prohibited. The College agrees to install, service,
and maintain any State-owned equipment issued to the teleworking employee. The Employee agrees to install,
service, and maintain any personal equipment used. Any equipment provided to the Employee must be returned
upon request by the College, upon resignation or termination of the Employee, or if the Teleworking Program is
discontinued by either the Employee or College. The College agrees to provide the Employee with all oce supplies
necessary to complete the assigned work tasks. (Attach addendum of College-owned equipment issued to the
Employee under the terms of this Agreement.)
O. Security
If the Employee is using College-owned equipment; (laptop computer, desk top, computer, printer, etc.) this
equipment must be properly maintained and protected from damage or theft. This may include ensuring that
electrical outlets are properly grounded and computer equipment protected with a power surge protector. The
employee is responsible for the proper use of college-owned equipment and supplies. Further, the employee assumes
responsibility for the loss of college-provided equipment and damage that results from negligent use or handling.
P. Liability
The employee understands that the College will not be liable for damages to the Employee’s personal or real property
while the Employee is working at the approved Alternative Site. Any damage to State-owned equipment not due to
normal wear and tear is the responsibility of the Employee.
REV. 09/12 | 10-11-090 J
Designated Alternative Worksite Agreement
Q. Injury Compensation
The Employee understands that State Worker’s Compensation liability is limited to injuries directly resulting from your
work and only if the injury occurs at the Employee’s designated Alternative Site or regular Duty Station. Any claims will
be handled by the College’s Human Resources Oce according to current Workers Compensation claims procedures.
The employee agrees to notify the supervisor immediately of any accident or injury that occurs at the Alternative Site
and to complete any forms required by the College and State of Washington. The supervisor agrees to investigate such
a report immediately.
R. Condential Materials
Condential materials will not be taken home by the Employee unless proper security measures are provided for
at home and only with the prior approval of the Employee’s supervisor. Disposal of condential materials is to
be completed only at the College’s facilities. The Employee agrees to protect College records from unauthorized
disclosure or damage and will comply with requirements of the Privacy Act of 1974, 5U.S.C. 552a.
S. Cancellation
The College agrees to allow the Employee resume his or her regular schedule at the regular Duty Station after the
Employee provides written notice to the supervisor. The Employee understands that the College may cancel the
teleworking arrangement or discontinue the Teleworking Program at any time at the sole discretion of the College
and instruct the Employee to resume working at the regular Duty Station. If the Employee chooses not to return to the
regular Duty Station, The College will consider this to be a voluntary resignation and it will be treated as such under
the College’s standard policies. The College agrees to follow any applicable administrative or negotiated procedures.
T. Other Action
Nothing in this agreement precludes the College from taking any appropriate disciplinary or adverse action against an
employee who fails to comply with the provisions of this agreement.
EMPLOYEE SIGNATURE DATE
SUPERVISOR SIGNATURE DATE
HUMAN RESOURCES SIGNATURE DATE
Distribution:
Original: Employee Personnel File
Copies: Employee
Supervisor
REV. 09/12 | 10-11-090 J
Designated Alternative Worksite Checklist
REV. 09/12 | 10-11-090 J
The following checklist is designed to assess the overall safety of your alternative worksite. Please read and complete
the self-certication safety checklist. Upon completion, you and your supervisor should sign and date the checklist in
the spaces provided. The checklist must be attached to the application and approved by Human Resources.
LAST NAME FIRST NAME
DEPARTMENT
ALTERNATIVE WORKSITE LOCATION (SPECIFIC ADDRESS)
PLEASE DESCRIBE THE ALTERNATIVE WORKSITE:
Workplace Environment
Do you have a separate dedicated (or restricted access) work area?
Are temperature, noise, ventilation, and lighting levels adequate for maintaining your normal
level of job performance?
Are all stairs with four or more steps equipped with handrails?
Are all circuit breakers and/or fuses in the electrical panel labeled as to intended service?
Do circuit breakers clearly indicate if they are in the open or closed position?
Is all electrical equipment free of recognized hazards that would cause physical harm (frayed
wires, bare conductors, loose wires, exible wires running through walls, exposed wires to the
ceiling)?
Will the building’s electrical system permit the grounding of electrical equipment?
Are aisles, doorways and corners free of obstructions to permit visibility and movement?
Are le cabinets and storage closets arranged so drawers and doors do not open into
walkways?
Do chairs have any loose casters (wheels)?
Are the rungs and legs of the chairs sturdy?
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
Designated Alternative Worksite Checklist
Are the phone lines, electrical cords, and extension wires secured under a desk or alongside a
baseboard?
Is the oce space neat, clean, and free of excessive amounts of combustibles?
Is the site serviced by a smoke alarm and does it contain a re extinguisher?
Are oor surfaces clean, dry, level, and free of worn or frayed seams?
Are carpets well secured to the oor and free of frayed or worn seams?
Is there enough light for reading?
Computer Workstation
Is your chair adjustable?
Do you know how to adjust your chair?
Is your back adequately supported by a backrest?
Are your feet on the oor or fully supported by a footrest?
Are you satised with the placement of your monitor and keyboard?
Is it easy to read the text on your screen?
Do you need a document holder?
Do you have enough legroom at your desk?
Is the screen free from noticeable glare?
Is the top of the screen eye level?
Is there space to rest the arms while not keying?
When keying, are your forearms close to parallel with the oor?
Are your wrists fairly straight when keying?
Does your desk have enough space on it for working materials?
Do you have storage space nearby for work les and materials?
Is your desk at a comfortable work height?
Is your desk sturdy enough to safely support a computer?
REV. 09/12 | 10-11-090 J
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
Designated Alternative Worksite Checklist
Hardware/Software
Do you have high speed internet access? (DSL, Cable Modem, ISDN)
If not, do you have a modem and an Internet Service Provider with a local access number?
If necessary for your work, do you have a Virtual Private Network (VPN) congured for
accessing college resources?
Does your work require access to the HP3000 system?
Do you have a modern web browser? (Internet Explorer 5.0 or later, FireFox, Safari, Opera 7,
Netscape 7)
Do you have Citrix?
Do you have a printer?
REV. 09/12 | 10-11-090 J
EMPLOYEE SIGNATURE DATE
SUPERVISOR SIGNATURE DATE
APPROVED DISAPPROVED APPROVED WITH THE FOLLOWING RECOMMENDATIONS
VP FOR HUMAN RESOURCES SIGNATURE DATE
APPROVED DISAPPROVED APPROVED WITH THE FOLLOWING RECOMMENDATIONS
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
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Telework Application (Edmonds Community College)

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Completed 23 July 2020

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