Work From Home Agreement
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1Work from Home Agreement
Applicant Details
Name of Staff Member
Position
Home office address
Home office phone
Email
Contact arrangements
Working from Home Arrangements
Number of days at home based worksite
Number of days at office based site
Commencement date of arrangement
End date of arrangement
Hours of work per week at home based
worksite
Specific Reason for home based work
Outline of agreed
deliverables/outcomes to be achieved
when working from home
Date of review
___/___/___
Checklist
Working from home self-assessment
Yes/No
checklist attached
I have read and understood the conditions set out in the Working from Home agreement procedure and
indicate my acceptance of the terms of this agreement by signing below.
Staff members signature
Date
___/___/___
Approved
Yes/No
Supervisors signature
Date
___/___/___
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Parent category: Business