Teleworker's Work Plan

TELEWORKER'S WORK PLAN

Teleworker______Supervisor/Manager ______

(Print name)

1.I agree to work at the following remote work location(s): (Please specify designated work area within the remote location.)

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2.My Teleworking work hours will be ______a.m./p.m. to ______a.m./p.m.

3.I will be unavailable from ______a.m./p.m. to ______a.m./p.m.

4.I agree to call and/or email the office to obtain messages at least every _____ min/hrs during the day while working at the remote work location.

5.The following employer-ownedequipment will be checked out for telework:

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6.The following task(s) and/or objective(s) are planned telework tasks:

______

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Anticipated time for task: _____

Actual time spent on task: Completed: Yes No

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Anticipated time for task: _____

Actual time spent on task: Completed: Yes No

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Anticipated time for task: _____

Actual time spent on task: Completed: Yes No

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Anticipated time for task: _____

Actual time spent on task: Completed: Yes No

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Anticipated time for task: _____

Actual time spent on task: Completed: Yes No

______

Anticipated time for task: _____

Actual time spent on task: Completed: Yes No

Unplanned Activities:

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Amount of time spent on task: Completed: Yes No

______

Amount of time spent on task: Completed: Yes No

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Amount of time spent on task: Completed: Yes No

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Amount of time spent on task: Completed: Yes No

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Amount of time spent on task: Completed: Yes No

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Amount of time spent on task: Completed: Yes No

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Amount of time spent on task: Completed: Yes No

This agenda has been agreed upon by the employee and the supervisor for the

Teleworking day or days of ______20___.

Supervisor/Manager's signature:

Date(s): ______

Supervisor/Manager Agenda Review

The goals and objectives agreed upon for the Teleworking day stated above were met by the employee as noted. The work listed was reviewed and supervisor concurs with accomplishment of assigned tasks (any exceptions noted).

Date: ______

Employee's signature: ______

Supervisor/Manager’ssignature: ______

Manager’s Comments: ______

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