Tool 2: Sample Remote Work Agreement and Plan

Tool 2

Sample Remote Work Agreement and Plan

Purpose

The purpose of this tool is to help working and soon to be parents, especially mothers, better balance their professional demands and newly added or imminent childcare responsibilities by fine tuning their work schedule.

Implementation

This tool can be used by mangers/supervisors or the HR Department to clearly define and communicate expectations and responsibilities of both the employee and her/his manager/supervisor during the period the employee has been authorized to participate in the remote/telework work program by her/his supervisor.

This document does not supersede or alter the terms of the existing employment contract and is subordinate to it in the case of conflicting provisions, except in the case of those specifically addressed in this Agreement.

Remote Work is available only to eligible employees, at the supervisor’s discretion, and is not an employee benefit intended to be available to the entire organization.

Eligibility

Employees who are in the last trimester of their pregnancy, or the caretaker of a child under school age, or of a child under 18 with a disability are eligible to request Remote Work arrangements to assist with the child’s care.

Section 1: Remote Work Duration:

Start Date:
End Date:

Notes:

1. This Agreement and the employee’s remote work will begin at the Start Date and will continue until the End Date specified above.
2. This Agreement must be renewed before the End Date if the employee expects to continue working remotely past the specified End Date.
3. The remote work arrangement and this Agreement may be discontinued at any time by the employee.
4. The remote work arrangement and this Agreement may be discontinued at any time by the supervisor with a written 7-day notice, with or without cause.

Section 2: Employee Information:

Employee Name:
Job Title / Designation:
Department:
Supervisor Name:
Employee ID Number:
Employee Phone Number:
Employee Email Address:
Type of Remote Work Requested:	☐ Fully Remote ☐ Partially Remote

Notes:

1. The employee must be reachable by telephone on the phone number provided here during office hours while on Remote Work.
2. The employee must respond to or acknowledge all email sent by the email address provided here by her or his supervisor within office hours.
3. The employee should select Fully Remote as Type of Remote Work Requested if she/he expects to perform all her/his duties away while remaining away from the office premises.
4. The employee should select Partially Remote as Type of Remote Work Requested if she/he expects to spend more than 5 hours a week at the office premises during office hours while performing her/his duties.

Section 3: Weekly Work Schedule and Location

Day of the Week	Work Hours	Work Location
Monday		☐ In Office ☐ Home Office
Tuesday		☐ In Office ☐ Home Office
Wednesday		☐ In Office ☐ Home Office
Thursday		☐ In Office ☐ Home Office
Friday		☐ In Office ☐ Home Office
Saturday		☐ In Office ☐ Home Office
Sunday		☐ In Office ☐ Home Office

Notes:

1. The Work Hours and Work Days for Remote Work is subject to negotiation with and approval by the supervisor. The supervisors can require that employee work certain and be accessible by telephone during those hours.
2. The Employee agrees to remain accessible by phone or email and agrees to respond during the specified Work Hours and Work Days, if not on supervisor approved leave.
3. This Agreement must be renewed if Work hours need to change during the duration of the Remote Work.
4. The supervisor reserves the right to occasionally require employees to attend important meetings and events when necessary.

Section 4: Equipment and Connectivity

Equipment/Service	Provided By
Computer / Laptop	☐ Employer ☐ Employee
Modem / Router	☐ Employer ☐ Employee
Internet Connectivity	☐ Employer ☐ Employee
	☐ Employer ☐ Employee
	☐ Employer ☐ Employee
	☐ Employer ☐ Employee

Notes:

1. Employee agrees to designate a workspace within his or her remote work location for placement and installation of equipment to be provided by the employer. Employee agrees to maintain this workspace in a safe condition, free from hazards and other dangers to Employee and the equipment.
2. The designated workspace must be ergonomically sound, free from disturbance and secure.
3. Any materials taken to the remote work location should be kept in the designated work area and not be made accessible to others.
4. The employee agrees to not use, or allow others to use, the equipment provided by the employer for purposes of remote work other than for employer business.
5. Office supplies will be provided by Employer as needed. Employee’s out-of-pocket expenses for other supplies will not be reimbursed unless by prior approval of the supervisor.
6. The employee understand that all equipment and materials provided by the employer shall remain the property of the employer.
7. The employee agrees to return employer equipment and materials, and cancel all employer financed services, within 7 days of termination of this agreement.
8. The employer will not be responsible for repairs and maintenance of any privately owned equipment provided by the employee for remote work.
9. Equipment provided by the employer will be serviced and maintained by the employer except for service or damage arising out of intentional destruction or gross negligence.
10. The employer will not pay for the utility costs associated with the use of the equipment or rent for occupation of the workspace.

Section 5: Other terms and Conditions

1. The employees job responsibilities and promotional opportunities will not change due to participation in the Remote work Agreement.
2. Salary, job responsibilities, and benefits will not change because of participation in Remote work Agreement, except as they might have changed had employee stayed in the office full-time.
3. Employee will be entitled to any company-wide benefits changes that may be implemented.
4. The amount of time employee is expected to work will not change due to participation in the Remote work Agreement. Employee is expected to remain accessible during designated work hours and comply with the commitments made in Section 3 of this Agreement.
5. Work and productivity maybe monitored by the supervisor without formal notice.
6. The employee is expected to meet established performance standards.
7. The employee will communicate regularly with his or her supervisor and co-workers, which includes a weekly written report of activities.
8. The employee understands that the supervisor or the employer retains the right to modify this Agreement on a temporary or permanent basis for any reason at any time.
9. All employer rules, policies, practices, instructions and guidelines, including but not limited to attendance, leave and overtime continue to apply, except those specifically addressed in this agreement.
10. The employee will report work-related injuries to his or her supervisor as soon as practicable.

Supervisor’s Signature and Date
Employee’s Signature and Date
HR Representative’s Signature and Date

 

Section 6: Process Map for requesting Flexible Work