Supervisors should use the following checklist to ensure that telecommuting requirements are met and that covered employees understand the policies and procedures of the telecommuting program. After an item is completed, list the date on the line next to it.

1.     Guidelines and outlining policies and procedures of the telecommuting program have been explained to the employee.     (Date Completed)__________

2.     The employee's most recent performance appraisal rating is "Fully Successful" or better.   (Date Completed)__________

3.     The provisions governing premium pay have been explained to the employee including that he/she must receive the supervisory approval in advance of working overtime.      (Date Completed)__________

4.    Performance expectations been discussed with the employee. Standards are in place and have been signed.      (Date Completed)__________

5.    Policies and procedures covering classified, secure and privacy data have been explained to the employee.     (Date Completed)__________

6.    The employee has been given the safety checklist which identifies safety and adequacy issues that employee should consider working from home.      (Date Completed)__________

7.    Equipment issued to the employee has been documented with        (Date Completed)___________
an OPM Form 4753, "Receipt and Pass for Property." Also, check items taken below, as applicable:

                        YES		    NO
-computer               _____           _____

-modem                  _____           _____

-fax machine            _____           _____

-telephone              _____           _____

-desk                   _____           _____

-chair                  _____           _____

-other                  _____           _____



____________________                                    ______________________                                                         			                                                      
Employee's signature				 Supervisor's signature