Fillable Usda Telework Agreement Ad-3018 (Page 2 of 3) in pdf

USDA Telework Agreement

U.S. DEPARTMENT OF AGRICULTURE

Employee’s official tour of duty must include at least a 30-minute uncompensated lunch.

Employee understands requirements for an adequate and safe office space and that these requirements must be met.

Employee’s Time and Attendance (T/A) for all official duty time spent in a Teleworking status will be recorded using the proper Telework time

code.

Employee agrees to follow policy for requesting and obtaining supervisory approval of leave.

Employee is covered under the Federal Employee’s Compensation Act in the course of performing official duties at the alternate work

location or official duty station. Any accident or injury which occurs at the alternate work location must be brought immediately to the

attention of the supervisor.

Employee’s most recent performance rating must be at least equivalent to “fully successful” (e.g., ‘pass’).

10. Employee understands that telework is not a substitute for dependent care (child care or elder care) and that appropriate arrangements

must be made to accommodate children and adults who cannot care for themselves, while performing official duties in a residential office.

11. Employee will apply approved safeguards to protect Government records from unauthorized disclosure or damage and will comply

with the provisions set forth in the Privacy Act of 1974, Public Act of 1974, Public Law 93-579, codified at Title 5, U.S.C., Section

55a.

12. This Telework agreement should be reviewed and discussed between the employee and supervisor on an annual basis.

13. Employees must have an approved Core or Ad Hoc Telework agreement in place, as well as available work, to include professional

development activities, appropriate equipment, or other means necessary to be able to perform work and stay connected, in order to be

considered Telework ready.

FOR THOSE EMPLOYEES THAT OPT-OUT

I fully understand that I am eligible to participate in USDA’s Telework Program. I acknowledge that I have been notified of my status

and at this time, voluntarily decline to participate in Telework in any capacity.

I understand that I may re-visit my decision to participate in the Telework Program at any time, provided that I meet the eligibility and

suitability requirements and complete a revised Telework Agreement Form.

TO BE COMPLETED BY SUPERVISOR:

APPROVED

DISAPPROVED

RETURNED FOR CORRECTION

REASON FOR DISAPPROVAL:

Eligible employees are not expected to receive a performance rating of at least “fully successful.”

Position duties require physical presence on a daily, every work day, basis and do not include any portable or administrative work that can be

accomplished during any portion of a duty day from an alternate office or location.

Position duties require access to and/or use of specialized equipment on a daily, every work day basis, located only at the traditional worksite and

do not include any portable or administrative work that can be accomplished during any portion of a duty day from an alternate office or location.

Position duties require access to the handling of classified materials on a daily, every work day basis, and do not include any portable or

administrative work that can be accomplished during any portion of a duty day from an alternative office or location.

Employee has received a less than fully successful performance rating within the past 12 months.

PERMANENT INELIGIBILITY pursuant to telework statute and Departmental Regulation.

Employee’s Signature

Date Signed

Supervisor’s Signature

Date Signed

Program Coordinator’s Signature

Date Signed

Please return this form to:

Attention: Telework Program Coordinator

Form AD-3018 Rev. (5/2014)

Usda Telework Agreement Ad-3018 Page 2

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