Temporary Telework Agreement Form

The purpose of this document is for both the supervisor and the employee to have a clear, shared understanding of the employee’s TEMPORARY telework arrangement. Each telework arrangement is unique depending on the needs of the position, supervisor, and employee.

This telework agreement is not a contract of employment and does not provide any contractual rights to continued employment. It does not alter or supersede the terms of the existing employment relationship. The employee remains obligated to comply with all Burrell College rules, policies, practices, and instructions that would apply if the employee were working at their regular worksite.

Employee Telework Information

Employee Name:*

First Last

Job Title:*

Department:*

Supervisor:*

First Last

Arrangement requested by:*

Employee
Department/College

Type of Telework Request:*

Temporary

Full-Time
Part-Time

List Telework Schedule:*

Location where telework will be performed:*

List Specific Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telework arrangement effective dates:*

If end date is known:

Reason For Request:*

Childcare
Mandated Virtual/Hybrid Schooling for School Age Children
COVID-19 Related

Please Explain:*

Additional Information Required, please provide information for all school age children living within your home for which you are the legal parent/guardian:*

Elementary School age child(ren) living at home
Middle School age child(ren) living at home
High School age child(ren) living at home
Other

Other (please explain):*

Please select applicable option below*

The employee is subject to a federal, state or local quarantine or isolation order related to COVID–19.
The employee has been advised by a health care provider to self-quarantine due to concerns related to COVID–19 (I.E. pre-existing conditions/high risk age group).
The employee is experiencing symptoms of COVID–19 and seeking a medical diagnosis.
The employee is caring for an individual who is subject to either number 1 or 2 above.

Please provide additional information on the reason selected above.*

Job Duties
The general expectation for a telework arrangement is that employees will effectively accomplish their regular job duties, regardless of work location.

While on telework, an employee will:
1. remain accessible during the telecommute work schedule;
2. check in with the supervisor to discuss status and open issues;
3. be available for teleconferences, scheduled on an as-needed basis;
4. be available to come into the office if a business need arises;
5. request supervisor approval in advance of working any overtime hours (if employee is non-exempt); and
6. request supervisor approval to use vacation, sick, or other leave in the same manner as when working at employee’s regular work location.
Employee’s duties, obligations, responsibilities, and conditions of employment with Burrell College remain unchanged except those obligations and responsibilities specifically addressed in this agreement. Job responsibilities, standards of performance, and performance appraisals remain the same as when working at the normally assigned duty station. The supervisor reserves the right to assign work as necessary at any work site.
The parties acknowledge that this agreement may be evaluated on an ongoing basis to ensure that employee’s work quality, efficiency, and productivity are not compromised by the telework arrangement described herein.

Either the employee or Burrell College may end an employee requested telework arrangement at any time. This form does not apply to telework arrangements made through the disability accommodation process, although it may be utilized to initial the disability accommodation process. All employee-proposed changes are subject to supervisor approval.

Equipment and technology access
Burrell College supervisors will work with their employee(s) to determine appropriate and suitable equipment. In the spaces below, specify any equipment or technology access the employee will need to telework and whether it will be employee or Burrell College provided. In the event of equipment failure or service interruption, the employee must notify their supervisor immediately to discuss alternate assignments or other options. Internet access should be through the VPN system.

Employee agrees to protect Burrell College-owned equipment, records, and materials from unauthorized or accidental access, use, modification, destruction, or disclosure. Data security is vital. The precautions described in this agreement apply regardless of the storage media on which information is maintained, the locations where the information is stored, the systems used to process the information, or the process by which the information is stored.

Employee agrees to report to employee’s supervisor any incidents of loss, damage, or unauthorized access at the earliest reasonable opportunity.

Employee understands that all equipment, records, and materials provided by Burrell College shall remain the property of Burrell College. If employee utilizes their own equipment, he/she is responsible for servicing and maintaining it. Burrell College will not be liable for damages to an employee’s personal or real property during the course of performance of official duties ow while using college equipment in the employee’s residence. The college will not be responsible for operating costs, home maintenance or any other incident costs (i.e utilities) associated with the use of the employee’s residence. The college will not provide additional equipment such as desks, chairs, printers, office supplies, etc. to set up and maintain a home office, this is the employee’s responsibility.

Equipment Provided:*

Telework - Timekeeping and Leave
Non-telework employees are expected to report to work as scheduled unless otherwise notified. Regular leave policies and procedures should be followed for employees who are unable to report to work.

Employees on telework should maintain accurate time records and supervisors are accountable for management of those records. Non-exempt employees should not perform any work related business when off the clock. Under the federal Fair Labor Standards Act (FLSA), non-exempt employees will be compensated for overtime that has been approved in advance by the supervisor in accordance with the provisions of the act.

Employees in exempt (salaried) positions are exempt from overtime regulations. Pursuant to established Burrell College policies, employees must obtain supervisory approval before taking leave.

Workers’ Compensation
Employee is covered by the Employer’s Workers’ Compensation insurance, if injured while performing official duties at the central workplace or alternate work location. Employee agrees to bring to the immediate attention of supervisor any accident or injury occurring at the alternate work location. Supervisor acknowledges and reports to Human Resources all accident and injury reports immediately following notification.

Safety Confirmation
Employee confirms that the alternate work location is, to the best of his/her knowledge, safe and free of recognized hazards that would cause physical harm (such as frayed, exposed or loose electrical wires; clean, dry, and level floor surfaces; phone lines and electrical cords are properly secured; etc.).

Name:*

First Last

Email:*

Enter Email Confirm Email

Signature*

Date:*

By signing this form electronically, it will be submitted and maintained by the Offices of Human Resources and IT.

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Temporary Telework Agreement Form

Temporary Telework Agreement Form

Employee Telework Information