PROTECTED WHEN COMPLETED	

TELEWORK AGREEMENT

A - INFORMATION ON EMPLOYEE'S CURRENT SITUATION	
Employee's name	Personal Record Identifier (PRI)	
Branch	Official workplace	
Other	
B - CONDITIONS OF THE TELEWORK ARRANGEMENT	

The following policy requirements have been or will be met in this telework arrangement : 
 
The employee and the manager/supervisor have read and agreed to respect the conditions of the Telework Policy. (include departmental web site or  
www.tbs-sct.gc.ca/pubpol_e.html#hrm).
 
Participation of both the employee and the employer in this telework arrangement is voluntary and may be cancelled or temporarily suspended at any time by either party with reasonable notice. 
 
The manager/supervisor and employee understand that the terms and conditions of employment, provisions of the relevant collective agreement and application of existing policies and legislation will continue to apply in telework situations. 
 
The manager/supervisor and employee have discussed and the employee has been given training on how to establish a safe and ergonomic work environment; any questions and concerns raised by the employee have been answered and dealt with to his/her satisfaction. 
 
The employee undertakes to adequately equip the teleworkplace from a safety, health and security point of view. 
 
The employee and the manager/supervisor have discussed the safe custody and control of sensitive information and the employee agrees to comply with the employer's security policies, standards and procedures and to take all reasonable care to protect sensitive government information and assets against unauthorized disclosure, loss, theft, fire, destruction, damage or modification.
	
¨	Additional Conditions are attached (please check)	
C - TERMS	
Teleworkplace address	Teleworkplace Telephone No.	
Telework period	Specify which days	Hours of work	
From   (Y/M/D)	To   (Y/M/D)	¨
Monday	¨
Tuesday	¨
Wednesday	¨
Thursday	¨
Friday	From	To	
D - SIGNATURES (The employer and the employee agree to the terms and conditions set out in this agreement)	
Employee's signature	Telephone No.
(        )	Date (Y/M/D)	
Manager or supervisor's signature	Telephone No.
(        )	Date (Y/M/D)	

Provision of the information requested on this form is voluntary.  This information is being collected for the purpose of a telework agreement and is essential to making a decision directly affecting you. This information will be stored in Personal Information Bank number PSE 901 - Employee Personnel Record.  It is protected from disclosure pursuant to the provisions of the Privacy Act.