University of Georgia Telework & Flextime Agreement Form
Please indicate which agreement type you would like to fill out.
Enter the date on which you are submitting this request.
Name of Person Submitting this form.
Email of Person submitting this form.
Please use legal name as it appears in OneUSG Connect.
This is your OneUSG Connect Employee ID. You can find this number under Personal Details (top left corner under your name) in OneUSG Connect Self Service or on your pay stub. This is NOT your 810 UGA number.
Please do not put your 810 or 811 number in this field. MYID EX: Hdawg21
Please fill in the Employee's UGA Email.
Please enter the employee's working title.
Employees who are in an Academic Advising position, must include the Dean of their college as one of the approvers
The following conditions for telecommuting have been agree upon by the employee and his/her supervisor.
Not to exceed one year, but renewable in one year increments.
Enter the number of days/week you will be telecommuting.
If schedule is outside the employee's normal working hours/days, please indicate when the employee will be working below.
Please explain how telecommuting/flexing time will support the overall goals of the unit and benefit the University of Georgia.
A complete work schedule is required. Please use the next two fields to indicate which days you will be working at UGA versus your alternative work site. The employee must be available between the hours of 8:00am and 5:00pm unless otherwise specified on this form.
List all days that apply. Use "No Days" if full time telework.
List all days that apply.
Please indicate which US State you will be working from. If outside of the US, please use "Outside US".
Please enter any additional comments as needed.
The next fields will determine how your request will route through approvals at your department. Please ensure that names and emails are filled in accurately and spelled correctly. Approvers are determined by your unit.
If you are unsure of your approver, please contact your unit’s HR Liaison. Your HR Liaison will be sent notifications by default based on your Unit/College selection.
Optional if required by unit. Please leave blank if not needed.
Optional if required by unit)
The following checklist is designed to assess the overall safety of your alternate worksite. The checklist is necessary to make you aware of the need for a safe workplace that is conducive for productive work. The safety guidelines are to provide you with information to assist you with maintenance of your telework location. Please read and complete the information regarding the designated work area. Discuss with your supervisor if you have questions.
Are temperature, noise, ventilation, and lighting levels adequate for maintaining your normal level of job performance?
Is all electrical equipment free of recognized hazards that would cause physical harm (frayed wires, bare conductors, loose wires, flexible wires running through walls, exposed wires to the ceiling)?
Are the phone lines, electrical cords, and extension wires secured under a desk or alongside a baseboard?
Is the office space neat, clean, and free of excessive amounts of combustibles?
The following checklist is designed to assess the overall safety of your alternate worksite. The checklist is necessary to make you aware of the need for a safe workplace that is conducive for productive work. The safety guidelines are to provide you with information to assist you with maintenance of your telework location. Please read and complete the information regarding the designated work area. Discuss with your supervisor if you have questions. • Are temperature, noise, ventilation, and lighting levels adequate for maintaining your normal level of job performance? • Is all electrical equipment free of recognized hazards that would cause physical harm (frayed wires, bare conductors, loose wires, flexible wires running through walls, exposed wires to the ceiling)? • Are the phone lines, electrical cords, and extension wires secured under a desk or alongside a baseboard? • Is the office space neat, clean, and free of excessive amounts of combustibles? Participating employees should use these recommended guidelines to assist them in a survey of the overall safety and adequacy of their alternate worksite. The following recommendations do not encompass every situation that may be encountered. Employees are encouraged to obtain professional assistance with issues concerning appropriate electrical service and circuit capacity for residential worksites. 1. Always report accidents and injuries immediately to your supervisor. 2. Develop and practice a fire evacuation plan for use in the event of an emergency. 3. Check your smoke detectors regularly and replace batteries as recommended. 4. Always have a working fire extinguisher at your telework location and check the charge as recommended. 5. Computers are heavy. Always place them on sturdy, level, well-maintained furniture. 6. Take the following into consideration when locating your computer: a. Place the monitor where there will not be any noticeable glare from windows or lighting. b. Place the monitor at a comfortable height for viewing. c. Locate the computer keyboard and mouse at a height that does not cause wrist strain. d. Use a surge protector and make sure all cables are grounded. 7. Always power down computers after the workday is over and always turn off all electrical equipment during thunderstorms. 8. Choose office chairs that provide good supporting backrests and allow adjustments to fit you comfortably. 9. Locate computers, phones and other electrical equipment in a manner that keeps power cords out of walkways. 10. Keep your work area clean and avoid clutter, which can cause fire and tripping hazards.
1. The employee must have a formal work schedule established defining standard hours of work in which the employee’s duties and responsibilities are performed. 2. The employee must agree to attend in-department meetings as called by management, or regularly scheduled communications virtually or by telephone or email. 3. The employee understands that, if he/she changes positions or is reallocated, it does not necessarily mean that he or she may continue to work at home. 4. The employee understands the alternative work arrangement can be changed or ended at any time by the supervisor regardless of the reason (with or without cause; with or without reason). The employee can also request to end the alternative work site arrangement. a. Under most circumstances, a reasonable notice period, no less than two weeks, should be provided. b. Notification of the decision to end the alternate location work arrangement will be conveyed verbally and in writing to the employee. 5. Management reserves the right to visit the employee’s alternate work site during business hours (normally 8 a.m. to 5 p.m. Monday through Friday unless otherwise stipulated). Managers and supervisors must have the employee’s permission to enter the employee’s alternate work site if the work site is private property. 6. Management reserves the right to remove any University-owned equipment, materials, working papers, official or working documents from the alternate work site. This includes computer hardware and software which is the property of the University of Georgia. University equipment used in an alternate work situation must be signed for by the employee. 7. Management reserves the right to change Conditions of Employment at any time. 8. Responsibilities of Department Managers and Supervisors: a. Management must establish a communication plan with the employee. This plan must include periodic scheduling of supervisor employee meetings, participation of the employee at regular employer-sponsored staff meetings, notification of office events, notification of University events, and periodic performance reviews. In situations where the employee is not able to reasonably attend meetings, then management will schedule a periodic/regular schedule of telephonic or email communication. A work plan should be developed by management with the employee. b. Management may inspect the alternate work site to ensure that it is suitable for executing the duties and responsibilities of the assigned position. Periodic inspections of the alternate work site may be conducted to ensure that guidelines are being followed and any University equipment being used is being properly maintained. If geography does not permit an inspection, then management should discuss with the employee where he/she will be working in the alternate site.
a. The employee must request vacation and sick leave as defined by the management and the University’s policies and procedures. The employee is responsible for notifying the supervisor if there is a need to take sick or annual leave. b. The employee agrees to assume complete responsibility for safeguarding all University-owned equipment to include computer hardware/software, transcription equipment, etc., which is provided for the worksite. c. The employee agrees not to allow and is responsible for safeguarding against use of any University-owned equipment by non University employees or other unauthorized individuals. The employee agrees not to use or allow use of any University-owned equipment, to include computer hardware/software, transcription equipment, etc., for non-University use. Non-University use includes employees or persons holding non-University jobs, independent contractor work, etc. The employee agrees to pay for repairs caused by external factors not work related. d. The employee is responsible for maintaining confidentiality and security at the alternate workplace, as the employee would at the primary workplace. The employee must protect the security and integrity of data, information, paper files, and access to agency computer systems. e. The employee must, as a pre-condition to working at an alternative site, set up an appropriate, dedicated work environment. f. The employee must sign the “Teleworking/Flexible Scheduling Agreement” form. g. The employee understands that all applicable Board of Regents and University of Georgia Policies and procedures apply to the teleworker and are subject to change per the employer.
I understand this telecommuting assignment is not an employment contract and may not be construed as such. I understand this work arrangement does not in any way release me from adherence with the University of Georgia and the Board of Regent policies or procedures. I also understand the telecommuting work assignment can be terminated at any time without notice. I certify that I have read, understand, and agree to comply with the terms of The University of Georgia Telecommuting Guidelines and the specific terms of this assignment. I understand that the University of Georgia is not liable for damages to the employee’s personal property while telecommuting, nor is it responsible for operating costs, home maintenance, or other incidental costs (e.g., utilities, home insurance, etc.). The University of Georgia is not responsible for damage caused by the unauthorized or misuse of UGA equipment and supplies assigned in accordance with the telecommuting agreement. While working at the alternate site, I will designate one area as my official workstation. I understand that the University of Georgia’s potential liability with on-the-job injury or occupational illness is restricted to this official workstation. I certify that my responses to the checklist are true and complete to the best of my knowledge. I understand that any erroneous, misleading, or fraudulent information is sufficient grounds to disqualify me from teleworking and/or may lead to further disciplinary action. I have read the Safety Guidelines for the Telework Location and have discussed any concerns with my supervisor.
https://hr.uga.edu/_resources/pdf/Teleworking_Flexible_Scheduling_Agreement.pdf