Telecommuter Agreement

							                                      University of Puget Sound
                                 Telecommuter Agreement

Name: _________________________________ Title: ___________________________
      (Please Print)
Department: ____________________________ Extension: _______________________
Home Address: ___________________________________________________________
Home Telephone: ________________________ E-mail address:____________________
Approximate Commuting Time - One Way: _____________________________________
Approximate Commuting Mileage - One Way: ___________________________________
Proposed Telecommuting Schedule:
In Office M Tu           W       Th      F      At Home: M Tu            W      Th     F
Hours:                                          Hours:
Proposed Start Date: _______________________________________________________
Frequency:       [ ] 2 days/week         [ ] 1 day/week           [ ] 2-3 days/month
                 [ ] Other (specify) ____________________________________
Attach to this form
[ ] a description of the types of work you propose to do at home;
[ ] a copy of your job description;
[ ] a description of the ways in which a telecommuting arrangement might improve your work
      quality and increase your productivity, contribute to the mission, goals, and objectives of the
      work unit, and generally benefit the University; and
[ ] a description of the mechanisms you propose to use to safeguard and protect records form
      unauthorized disclosure or damage.
Please specify your designated home work space: ______________________________________
Is there someone (children, elders, disabled persons) in your home who requires supervision
during your telecommuting hours?         [ ] Yes         [ ] No
If yes, have dependent care arrangements been made during your telecommuting hours?
                                         [ ] Yes         [ ] No


[ ]      I have read and agree to abide by the University of Puget Sound’s Telecommuting policy.
[ ]   I understand telecommuting is a mutually agreed upon work alternative between me and
      the University of Puget Sound, as indicated by my supervisor’s, department head’s and
      area vice president’s approval, for the benefit of the University. I understand that I , my
      supervisor, department head, and/or area vice president may end a telecommuting
      arrangement at any time.

[ ]   I agree to participate in any telecommuting training and evaluation activities recommended
      by my supervisor.

[ ]   I agree to keep my supervisor informed of my progress on assignments worked on at
      home, including any problems which I may experience. My supervisor and I have agreed
      upon a work planning/monitoring process for my telecommuting day(s).

[ ]   I agree to structure my time to ensure my attendance at required meetings and University
      of Puget Sound events as designated by my supervisor.

[ ]   I understand and accept the special responsibility I have as a telecommuter to facilitate
      communication with my clients and colleagues who may be (or who may perceive to be)
      inconvenienced by my telecommuting. I further agree to make a special effort to stay
      current on department events that occur on my telecommuting days which may affect my
      work.

[ ]   I understand that any University equipment I use at home must be protected against
      damage and unauthorized use, that equipment owned or provided by the University will be
      serviced and maintained by the University, that access to University equipment at my
      home must be granted to appropriate officials, and that equipment I provide will be at no
      cost to the University and will be maintained by me.

[ ]   I understand that the University will not be responsible for operating costs, home
      maintenance, or any other incidental costs (e.g., utilities) associated with the use of my
      residence.

[ ]   I agree to maintain my home work space with appropriate safety considerations, with
      adequate lighting and ventilation, and free from distractions.

[ ]   I understand that I must safeguard and protect records from unauthorized disclosure or
      damage and that all records are the property of and must be returned to the University.

                             _______________________________                __________________
                             Staff Member’s Signature                       Date
              Approved:        _______________________________           __________________
                               Supervisor                                Date

              Approved:        _______________________________           __________________
                               Department Head                           Date

              Approved:        _______________________________           __________________
                               Area Vice President/Dean                  Date

Check the following equipment/services that will be used while telecommuting. Please specify
who will provide it (the staff member or the University):

Equipment/services                          Staff Member                 University
[ ] Second telephone line
[ ] Phone answering machine
[ ] Residential voice mail
[ ] Computer
[ ] Computer surge protector
[ ] Software (specify)
        _______________
        _______________
        _______________
        _______________
        _______________
        _______________
[ ] Printer
[ ] Modem
[ ] FAX machine
[ ] Other (specify)
        _______________
        _______________
        _______________
        _______________
        _______________
        _______________

Other conditions of the agreement:




cc: Human Resources Department