"Self-certification Checklist for the Telework Office Site" - Florida

Self-certification Checklist for the Telework Office Site is a legal document that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida.

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Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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FDJJ – 1025 - 3
Department of Juvenile Justice
Self-Certification Checklist for the Telework Office Site
/
/
Name of Teleworker / Class Title
People First ID / Position Number
Office (e.g. Probation, Administration)
Unit/Program Name
Telework Office Site Address
City
State
Zip Code
This checklist is for use by the teleworker in assessing the adequacy of the telework office site
environment.
The success of the teleworking arrangement depends on a realistic
assessment of the workspace, and the ability of the employee to successfully complete their
work in this environment. If the workspace is not adequate, the teleworking agreement will
not work. The teleworker will need to assess the office space to ensure that the space is
adequate, safe and hazard free.
Yes
No Does the space seem adequately ventilated?
Yes
No Is the space reasonable quiet and free of distractions?
Yes
No Are all the stairs with 4 or more steps equipped with handrails?
Yes
No Are all circuit breakers and/or fuses in the electrical panel labeled as to
intended services?
Yes
No Do circuit breakers clearly indicate if they are in open or closed position?
Yes
No Is all electrical equipment free of recognized hazards that would cause
physical harm (e.g. frayed wires, bare conductors, loose wires, flexible wires
running through walls, exposed wires fixed to the ceiling)?
Yes
No Are electrical outlets 3 pronged (grounded)?
Yes
No Is the computer equipment connected to a surge protector?
Yes
No Are aisles, doorways, and corners free of obstructions to permit movement?
Yes
No Are file cabinets and storage closets arranged so drawers and doors do not
open into walkways?
Yes
No Is the space crowded with furniture?
Yes
No Are the phone lines, electrical cords, and extension wires secured under a
desk or alongside the baseboard?
Yes
No Are floor surfaces clean, dry, level, and free of worn or frayed seams?
Yes
No Are carpets well secured to the floor, and free of frayed or worn seams?
Yes
No Is there a fire extinguisher in the home, easily accessible from the office
space?
Yes
No Is there a working smoke detector detectable from the workspace?
Teleworker Signature
Date
FDJJ – 1025 - 3
Department of Juvenile Justice
Self-Certification Checklist for the Telework Office Site
/
/
Name of Teleworker / Class Title
People First ID / Position Number
Office (e.g. Probation, Administration)
Unit/Program Name
Telework Office Site Address
City
State
Zip Code
This checklist is for use by the teleworker in assessing the adequacy of the telework office site
environment.
The success of the teleworking arrangement depends on a realistic
assessment of the workspace, and the ability of the employee to successfully complete their
work in this environment. If the workspace is not adequate, the teleworking agreement will
not work. The teleworker will need to assess the office space to ensure that the space is
adequate, safe and hazard free.
Yes
No Does the space seem adequately ventilated?
Yes
No Is the space reasonable quiet and free of distractions?
Yes
No Are all the stairs with 4 or more steps equipped with handrails?
Yes
No Are all circuit breakers and/or fuses in the electrical panel labeled as to
intended services?
Yes
No Do circuit breakers clearly indicate if they are in open or closed position?
Yes
No Is all electrical equipment free of recognized hazards that would cause
physical harm (e.g. frayed wires, bare conductors, loose wires, flexible wires
running through walls, exposed wires fixed to the ceiling)?
Yes
No Are electrical outlets 3 pronged (grounded)?
Yes
No Is the computer equipment connected to a surge protector?
Yes
No Are aisles, doorways, and corners free of obstructions to permit movement?
Yes
No Are file cabinets and storage closets arranged so drawers and doors do not
open into walkways?
Yes
No Is the space crowded with furniture?
Yes
No Are the phone lines, electrical cords, and extension wires secured under a
desk or alongside the baseboard?
Yes
No Are floor surfaces clean, dry, level, and free of worn or frayed seams?
Yes
No Are carpets well secured to the floor, and free of frayed or worn seams?
Yes
No Is there a fire extinguisher in the home, easily accessible from the office
space?
Yes
No Is there a working smoke detector detectable from the workspace?
Teleworker Signature
Date