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Sample Telecommuting Assignment/Checklist

Telecommuting is an arrangement that _______________________________________(Employer) may choose to make available to some employees when a mutually beneficial situation exists.

These are the conditions for telecommuting agreed upon by the telecommuter and his supervisor. This arrangement can be terminated by either the employee or the employer at any time.

  1. The employee agrees to work at the following location:_______________________________________________________
  2. The employee will telecommute ________ days per week, or as scheduled/needed.
  3. The employee's work hours will be as follows:_________________________________________________________ _______________________
  4. The assignments the employee will work on at the Telecenter with the expected delivery dates are:_____________________________________________________________ ________________________________________________________
  5. The following equipment will be used by the employee at the Telecenter:______________________________________________________ _____________________________
  6. The following software will be used by the employee at the Telecenter:______________________________________________________ _________________________
  7. The arrangement for payment of telephone calls/data transfer made by the telecommuter from the Telecenter for Company business is:______________________________________________________________ __
  8. The telecommuter has read and understands all company and Telecenter policies regarding telecommuting.
  9. Additional conditions agreed upon by the telecommuter and the telemanager are as follows:_________________________________________________________ ___

I have reviewed the above materials with my telemanager prior to working at the Telecenter.

Date_________ Telecommuter____________________________________________

I have discussed the above materials with my telecommuter.

Date_________ Telemanager_____________________________________________

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