TELEWORK WORK PLAN
This Telework Work Plan is intended to clearly define work expectations each time an
employee works at a remote work site. Teleworkers who fail to complete this Work Plan
and/or telework assignments to the satisfaction of the supervisor will not be permitted to
continue to telework, and failure to complete work assignments may negatively affect the
employee’s performance rating, and/or result in disciplinary action.
1. A Work Plan must be completed by both the teleworker and the supervisor
before each telework day.
2. The teleworker must complete Part I of this Work Plan to acknowledge an
understanding of the general telework requirements before teleworking.
3. The supervisor must complete Part II of this Work Plan to identify the specific
assignments to be performed during the telework day and the specific
deliverables associated with those assignments.
4. During the telework day, the teleworker must complete Part III of this Work Plan,
detailing the work performed during each hour of the telework day.
5. After the telework day, the teleworker must provide the Work Plan and
associated deliverables to the supervisor.
6. The supervisor must submit the completed Work Plan to the Agency Personnel
Office within one week of the telework day.
Teleworker’s Name: _________ Telework Date: ______________
PART I: General telework requirements:
By initialing next to each item, I (teleworker) certify that I understand and agree to
adhere to each of the following requirements:
_____ I agree to provide a home or remote work site telephone number where I may be
reached at all times (cell phone numbers may not be substituted for a home or
remote work site number unless Employee certifies that there is no land line
within the home or remote work site.) Phone number: _____
_____ I agree to respond to phone messages and emails at least hourly during each
_____ I agree to call my supervisor at least twice during each telework occasion.
_____ I agree to respond to calls from the main office within 15 minutes of the call.
_____ I agree to provide the specific deliverables, as detailed below, to my supervisor
on my next regularly scheduled workday in the office.
_____ I agree to comply with all provisions of this Work Plan and acknowledge that
failure to comply with these provisions will result in the termination of my
participation in a teleworking arrangement, may negatively affect my
performance rating, and may result in disciplinary action.
PART II: Assignments and Deliverables (To be completed by the Supervisor)
ASSIGNMENT SPECIFIC DELIVERABLE OF COMPLETION
PART III: Hourly Work Log
HOUR WORK DESCRIPTION
7:00 a.m. – 8:00 a.m.
8:00 a.m. – 9:00 a.m.
9:00 a.m. – 10:00 a.m.
10:00 a.m. –11:00 a.m.
11:00 a.m. – 12:00 p.m.
12:00 p.m. – 1:00 p.m.
1:00 p.m. – 2:00 p.m.
2:00 p.m. – 3:00 p.m.
3:00 p.m. – 4:00 p.m.
4:00 p.m. – 5:00 p.m.
5:00 p.m. – 6:00 p.m.
Teleworker’s Signature Date
Supervisor’s Signature Date
Agency Personnel Officer’s Signature Date
Telework Work Plan DBM-OPSB April 2009