DOJ Telework Agreement Form at a glance
What it is: The DOJ Telework Agreement Form, Part 2: Telework Agreement, is an agreement on the terms and conditions of the telework arrangement between the employee and the Department of Justice.
Who signs: The employee signs on the Employee's signature line: I hereby agree to the telework Terms of Agreement and certify that my telework location is in compliance with all listed safety criteria. The supervisor signs on the Supervisor's signature line in Part 3: Immediate Supervisor's Review.
A filled-in DOJ Telework Agreement Form example: a new telework agreement
How to fill out DOJ Telework Agreement Form, box by box
Action Requested and Employee Information
Under Action Requested, mark New, Change or Termination and enter the Date of Request.
Under Employee Information, enter the Employee Name, Component/Division and Office, and the Work Phone, Work Mobile Phone, Home Phone and Cell Phone.
Enter the Supervisor's Name.
Part 2: Telework Agreement
If the telework is Situational (Ad Hoc: short period of time, project based, unscheduled or weather related), mark Situational and provide examples of approved telework situations.
2. Enter the period beginning and ending for which the employee agrees to participate; the terms of this agreement should be reviewed and updated annually.
3. The supervisor and employee agree to the work schedule for the telework location: enter the Start Time and the Stop Time.
Worksites and telework locations
4. The Employee's official worksite: Street Address, City, State and Zip Code go in the boxes.
5. If different from the employee's official worksite, enter the agency worksite with its Street Address, City, State and Zip Code.
6. The approved telework locations are the Primary telework location and the Secondary telework location, each with Street Address, City, State and Zip Code; describe in detail the designated work area at the telework locations.
Telework training and equipment
8. Enter the date the employee completed telework training.
9. OPTIONAL: for the equipment issued to the employee and documented by the agency, enter the Description, Issue Date, Serial Number, DOJ Property Tag # and Return Date of the Computer, Mobile Phone, Monitor, Safe and Other.
Initial
16. Initial: the employee may voluntarily terminate a telework agreement at any time, and supervisors may remove the employee from a telework agreement in accordance with DOJ telework policies, established administrative procedures, and union negotiated agreements.
Safety Checklist for Telework Locations
Each participant should read the safety checklist and certify that all telework locations are in compliance with all listed safety criteria.
Safety feature 1: is the space free of indoor air quality hazards such as asbestos and mold? Mark Yes or No.
Safety feature 2: is the work space equipped with fire, smoke, and carbon monoxide detectors? Mark Yes or No.
Safety feature 3: are stairways and walkways nonslip and free of obstructions and trip hazards? Mark Yes or No.
Safety feature 4: is all electrical equipment free of recognized hazards that would cause physical harm? Mark Yes or No.
Safety feature 5: are all areas free of obstructions to permit visibility and movement? Mark Yes or No.
Employee's signature
Sign on the Employee's signature line and enter the Date.
Part 3: Immediate Supervisor's Review
In Part 3, the Immediate Supervisor's Review, mark Approval, Approval with modification (please describe) or Disapproval (state reason), then sign on the Supervisor's signature line and enter the Date.
Distribution of Copies: Original - Approving Official, Copy - Employee, Copy - Human Resources.
More rules for DOJ Telework Agreement Form
1. Telework is not an employee right or entitlement. The employee volunteers to telework and agrees to adhere to all laws, regulations, and policies. The Department concurs with employee participation and agrees to adhere to all laws, regulations, and policies.
10. All timekeeping, leave, performance requirements, and special pay approvals are the same as for the traditional worksite.
11. Provided the employee is given at least 24 hours advance notice, the employee agrees to allow the supervisor or a designee, to inspect the telework location during the employee's normal working hours.
12. The employee agrees to immediately notify the supervisor of any work-related accident, injury, or illness occurring at the telework location and timely submit completed Occupational Injury/Illness Forms, as appropriate.
13. The Government will not be liable for damages to an employee's personal or real property during the course of performance of official duties or while using Government equipment in the employee's telework location, except to the extent the Government is held liable by Federal Tort Claims Act.
14. The Government will not be responsible for operating costs, home maintenance, or any other incidental costs whatsoever, associated with the use of the employee's residence. While teleworking, the employee is entitled to reimbursement for authorized expenses incurred while conducting business for the Government, as provided for by statute and implementing regulations.
15. The employee will apply approved safeguards when teleworking to protect Government/agency records from unauthorized disclosure or damage and comply with all Department and Component policies and regulations regarding classified, unclassified and other sensitive information. Production, transmission, storage and disposal of records will be in compliance with Department policies and regulations.
17. The employee agrees to limit performance of assigned duties to the approved telework location. Failure to comply with this provision may result in termination of the telework agreement and appropriate disciplinary action.
18. The employee agrees that they may be required to telework outside of their normal telework schedule in the case of a temporary emergency situation (e.g., worksite closure, authorized early dismissal, authorized delayed arrival, declaration of COOP status).
19. The employee certifies that adequate dependent care arrangements are in place and will not interfere with the employee's ability to telework.
7. Employee has completed the Safety Checklist for Telework Locations. Employee and supervisor have discussed requirements for an adequate and safe work area and the employee certifies that all approved telework locations meet those requirements.
Sources
[1] DOJ Telework Agreement Form, U.S. Department of Justice (the Official source link on this page).