"Employee Self-assessment Form - Telework Toolkit"

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Employee Self-Assessment Form
Before applying to telework, use this form to help you decide if you are ready. This isn’t a test;
instead it is an exercise to make sure you have considered the issues that may limit the amount of
telework you can do. When you apply for telework, your manager may want you to bring this
form so you can discuss the results together.
Telework Frequency
Your organization, or your supervisor, may weigh various factors when determining how frequently you can
telework, for example, the amount of your work that can be done remotely, how often you need to meet with
clients and if that can be scheduled around telework or done at the client’s office, how often you need to be
present for meetings, etc. In addition, your supervisor may limit frequent telework to employees with a lot of
experience. You may need to start with only one day a week and apply for additional days over time. In
many positions, the greater the frequency of working from home, the greater the need to be “networked” to
the office computer system. This may also play a role in your supervisor’s decision.
Have you considered each of the following when thinking about how often to work at home
versus in the office?
Write in any thoughts you have about how you will adapt or make arrangements to
accommodate these issues.
Notes
Amount of your work that can be
done just as well from home
The need to attend staff meetings
The need to work in person with
project team
Being there to assist coworkers with
questions/problems
Missing the social interaction with
colleagues
Meeting with clients / Ability to
schedule client meetings
Having access to files & documents
Access to special equipment
Security requirements of your work
How home life might be affected by
telework
How frequently do you want to telework?
Occasionally
Once a week
Twice a week
3 times a week
4 times a week or more
Telework Toolkit
Self-Assessment Form
Page 1 of 2
Employee Self-Assessment Form
Before applying to telework, use this form to help you decide if you are ready. This isn’t a test;
instead it is an exercise to make sure you have considered the issues that may limit the amount of
telework you can do. When you apply for telework, your manager may want you to bring this
form so you can discuss the results together.
Telework Frequency
Your organization, or your supervisor, may weigh various factors when determining how frequently you can
telework, for example, the amount of your work that can be done remotely, how often you need to meet with
clients and if that can be scheduled around telework or done at the client’s office, how often you need to be
present for meetings, etc. In addition, your supervisor may limit frequent telework to employees with a lot of
experience. You may need to start with only one day a week and apply for additional days over time. In
many positions, the greater the frequency of working from home, the greater the need to be “networked” to
the office computer system. This may also play a role in your supervisor’s decision.
Have you considered each of the following when thinking about how often to work at home
versus in the office?
Write in any thoughts you have about how you will adapt or make arrangements to
accommodate these issues.
Notes
Amount of your work that can be
done just as well from home
The need to attend staff meetings
The need to work in person with
project team
Being there to assist coworkers with
questions/problems
Missing the social interaction with
colleagues
Meeting with clients / Ability to
schedule client meetings
Having access to files & documents
Access to special equipment
Security requirements of your work
How home life might be affected by
telework
How frequently do you want to telework?
Occasionally
Once a week
Twice a week
3 times a week
4 times a week or more
Telework Toolkit
Self-Assessment Form
Page 1 of 2
Here are some factors for you to consider. Think about each and record any concerns you
have and how you will address them in order to telework.
Job Performance: How well do you know the job and your organization? Do you consistently meet
deadlines? Do you show up on time to work and to meetings? Can you work independently without
the need to frequently check with your manager?
Self-Discipline: Can you get the job done when no one is watching? Do you have good time
management skills? Can avoid the distractions of family, household chores, and television? If friends
or neighbors call or drop buy too often, will you be able to tell them to leave so I can get back to work?
Communication: Do you have the ability to stay in close communication with your manager and
coworkers when working remotely? Will you return calls, emails, and other messages quickly? Are
you willing to work with your manager to find a way to communicate assignments and progress?
Technology: Are you willing to learn, any software that may be required to work from home, such as
Instant Messaging or Web Conferencing software? If you are using your own equipment, are you
willing to run antivirus software or other currently licensed programs required by your employer?
Home Office: Do you have a suitable space at home that you can use as a home office? Are you
willing to give up some of your living space to create a home office? Your employer may have a
number of requirements for the design and outfitting of a home office, and may make an inspection to
verify these requirements have been met.
Working Alone: Not everyone is comfortable working alone. Some people miss the social
interaction and feel isolated if they work alone too often. Have you considered what it will be like to
work alone for the number of days you requested?
Co-Workers: How will your coworkers be affected by you working at home the number of days you
requested? Do they rely on you for help? Do you rely on them? If you telework, will it mean extra
work for your coworkers? Will they be covering for you? Will coworkers resent you teleworking?
Desk Sharing: Teleworkers who work at home a lot sometimes have to give up their regular desk
back at the office. When they go into the office they share a desk or reserve a desk. How do you feel
about this?
Telework Toolkit
Self-Assessment Form
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