Sample Supervisor's Employee Checklist
The following checklist is designed to ensure that employees participating in the teleworking/telecommuting
program are properly oriented to the policies and procedures of the project.
1. Employee has read guidelines outlining policies and procedures for teleworking/flexiplace participation. Yes [__]
Date: _______________________
2. Equipment has been issued to the employee and has been documented.
Computer Yes [__]Modem Yes [__]
Fax machine Yes [__]
Telephone Yes [__]
Desk Yes [__]
Chair Yes [__]
Other ____________________________ __ Yes [__]
______________________________ Yes [__]
______________________________ Yes [__]
______________________________ Yes [__]
Issue Date: ____________________________
Document Completion Date: ____________________
3. Policies and procedures for care of equipment have been explained and are clearly understood.
Date: _________________________
4. Policies and procedures covering classified, secure, and privacy act data have been discussed and are clearly understood.
Date: _________________________
5. Requirements for an adequate and safe office space and/or area have been discussed and actioned.
Date: _________________________
6. Performance expectations have been discussed and are clearly understood.
Date: _________________________
7. Employee understands that supervisor may terminate participation at any time.
Date: _________________________
8. Employee has participated in required telework/telecommuting training.
Supervisor signature: ___________________________ Date: __________________
Employee signature: ____________________________ Date: __________________
