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PREVIOUS EDITION IS OBSOLETE. DD FORM 2946, DEC 2011

DEPARTMENT OF DEFENSE 

TELEWORK AGREEMENT

PRIVACY ACT STATEMENT 

 

AUTHORITY: 10 U.S.C. 113, Secretary of Defense; DoD Instruction 1035.01, Telework Policy. 

PRINCIPAL PURPOSE(S): Information is collected to register individuals as participants in the DoD alternative workplace program; to manage and 

document the duties of participants; and to fund, evaluate and report on program activity. The records may be used by Information Technology offices to 

determine equipment needs, to ensure appropriate safeguards are in place to protect government information, and for assessing and managing 

technological risks and vulnerabilities. 

ROUTINE USE(S): None. 

DISCLOSURE: Voluntary; however, failure to provide the requested information may result in your inability to be a participant in the telework program.

TERMS OF TELEWORK AGREEMENT

The terms of this agreement must be read in conjunction with Department of 

Defense (DoD) telework policy, available on the DoD Issuances Web Site at 

http://www.dtic.mil/whs/directives/ or on the Civilian Personnel Management 

Service Web Site at www.cpms.osd.mil and any additional guidance provided 

by the employing organization. Signatories certify they will abide by this 

agreement, DoD telework policy, and all supplemental terms established by 

the employing organization. 

 

1. Work schedules and hours of duty may be modified as necessary, but are 

subject to local management procedures and approval and/or collective 

bargaining agreement requirements. A copy of the employee's approved work 

schedule should be kept on file with the signed telework agreement. In 

emergency situations (as indicated in Section I, Block 12 of the telework 

agreement), the teleworker's work hours may be subject to change. 

Emergency schedules will be set based on mission needs. 

 

2. If the employee reports to the regular worksite at least twice per pay period, 

the regular worksite is the official worksite as defined in part 531.605, subpart 

F of title 5, Code of Federal Regulations. 

 

3. If the employee does not report to the regular worksite at least twice each 

biweekly pay period, the official worksite is the location of the employee's 

telework site. Exceptions to the twice each biweekly pay period requirement 

may be made during emergencies (including a pandemic) and for short-term 

situations (e.g., special projects, medical accommodation). 

 

4. All pay (to include locality pay or local market supplement), leave, and travel 

entitlements are based on the employee's official worksite as documented on 

a Notice of Personnel Action. 

 

5. Prior to signing this Telework Agreement, the supervisor and employee will 

discuss: a. Office procedures (e.g., procedures for reporting to duty, 

procedures for measuring and reviewing work, time and attendance, 

procedures for maintaining office communications); b. Safety, technology and 

equipment requirements; and c. Performance expectations. 

 

6. Employee will not work in excess of the prescheduled tour of duty (e.g., 

overtime, holiday work, or Sunday work) unless he or she receives permission 

from the supervisor. By signing this form, the employee acknowledges that 

failure to obtain proper approval for overtime work may result in cancellation of 

the telework agreement and may also include appropriate disciplinary action. 

 

7. If designated employee (as indicated in Section I, Block 12 of this 

agreement) is unable to work due to illness or dependent care responsibilities, 

the employee must take appropriate leave. Supervisors may, on a case-bycase basis, administratively excuse the designated teleworker from 

teleworking if circumstances, such as a power failure or weather related 

emergency, prevent the employee from working at the telework site. To the 

extent practicable, managers will include a description of emergency duties 

with this agreement if emergency duties are different from the employee's 

prescribed duties and responsibilities. 

8. Teleworkers may be required to return to the regular worksite on scheduled 

telework days based on operational requirements. In situations where the 

employee is called to return to the office outside normal work hours, the recall 

shall be handled in accordance with established policy and/or collective 

bargaining agreements, if applicable.

9. If the employee uses Government-furnished equipment (GFE), the 

employee will use and protect the equipment in accordance with the DoD 

Component's procedures. GFE will be serviced and maintained by the 

Government. 

 

10. The employee agrees to comply with the terms of computer software 

license and copyright agreements, computer virus and protection 

requirements and procedures. 

 

11. No classified documents (hard copy or electronic) may be taken to, 

or created at, an employee's alternative worksite. If classified telework is 

authorized at an approved alternative secure location, teleworkers must 

comply with the procedures established by DoD 5200.01-R and the DoD 

Component regarding such work. For Official Use Only (FOUO) and 

controlled unclassified information (CUI) data may be taken to 

alternative worksites if necessary precautions are taken to protect the 

data, consistent with DoD regulations. 

 

12. When CUI including competition sensitive or source selection data is 

authorized for use at the telework location, criteria for the proper encryption 

and safeguarding of such information and data must be consistent with 

Enclosure 3, subparagraphs 3.f.(1) through (3) of DoDI 1035.01, Telework 

Policy. Component specific instructions must be included in the space allowed 

for Component specific comments or cite the appropriate Component 

references that contain these instructions. 

 

13. The supervisor will determine how frequently, if at all, backup copies of 

data onto network drives or removable disks must be made to protect against 

loss of data. The supervisor may also require the employee to periodically 

send backup copies to the main work facility. 

 

14. The employee may be reimbursed for authorized expenses (e.g., 

installation of broadband or telephone lines) incurred while conducting 

business for the Government, as provided by statute and implementing 

regulations and as articulate. d in this agreement. (Approved authorizations 

are filed with this agreement.) 

 

15. The employee will apply approved safeguards to protect Government 

records from unauthorized disclosure or damage and will comply with 

Privacy Act requirements set forth in the Privacy Act of 1974, and 

codified at section 552a of title 5, United States Code. The use of personal 

email accounts for transmission of Personally Identifiable information (PII) is 

strictly prohibited. PII may only be emailed between government email 

accounts and must be encrypted and digitally signed. 

 

16. The DoD Component may inspect the home worksite, by appointment 

only, if the DoD Component has reason to suspect that safety standards are 

not being met and GFE is not being properly maintained. 

 

17. The DoD Component will not be responsible for operating, maintenance, 

or any other costs (e.g., utilities) associated with the use of the employee's 

residence. 

 

18. The DoD Component is not liable for damages to an employee's personal 

or real property while the employee is working at home, except to the extent 

the Government is held liable by the Federal Tort Claims Act or from claims 

arising under the Military Personnel and Civilian Employees Claims Act.
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TERMS OF TELEWORK AGREEMENT (Continued)

19. Employees paid from appropriated funds are covered under the 

Federal Employee's Compensation Act if injured in the course of 

performing official duties while at the official alternative worksite. 

Employees paid from nonappropriated funds are covered under the 

Longshore and Harbor Workers' Compensation Act. Any accident or 

injury occurring at the alternative workplace must be brought to the 

immediate attention of the supervisors who will investigate all reports 

as soon as practical following notification. 

 

20. The employee acknowledges that telework is not a substitute for 

dependent care. 

 

21. The employee acknowledges that telework is a discretionary 

alternative workplace arrangement. The employee may be required to 

work at the regular worksite on scheduled telework day(s) if 

necessary to accomplish the mission. 

22. Either the employee or the supervisor can cancel the telework 

agreement. When possible, advance written notice should be 

provided. Management will terminate the telework agreement should 

the employee's performance or conduct not meet the prescribed 

standard or the teleworking arrangement fail to meet organizational 

needs. 

 

23. The employee continues to be covered by DoD Component 

standards of conduct while working at the alternative worksite. 

 

24. The employee has assessed the telework location against the 

attached safety checklist and certifies the location meets all safety 

requirements. 

 

25. DoD Component-specific conditions may be included below. 

COMPONENT-SPECIFIC TERMS AND CONDITIONS
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PREVIOUS EDITION IS OBSOLETE. DD FORM 2946, DEC 2011

DEPARTMENT OF DEFENSE 

TELEWORK AGREEMENT 

 (Read Privacy Act Statement and Terms of Agreement before completing this form.)

SECTION I - This document constitutes the terms of the telework agreement for:

1. EMPLOYEE (Last Name, First, Middle Initial) 2. OFFICIAL JOB TITLE

3. PAY PLAN/SERIES/GRADE/PAY BAND 4. ORGANIZATION

5. REGULAR OFFICIAL WORKSITE (Street, Suite Number, City, State, and 

ZIP Code)

6. ALTERNATE WORKSITE ADDRESS (Street, Apartment Number, City, 

State, and ZIP Code) (May be TBD under emergency situations)

7. ALTERNATE WORKSITE TELEPHONE NUMBER (Include Area Code) 8. ALTERNATE WORKSITE EMAIL ADDRESS (Address for official emails if 

different from office email address. Identification of personal email address is 

not required.)

9. TELEWORK ARRANGEMENT IMPLEMENTATION DATES 

(Agreement should be revalidated at least once every 2 years)

a. START (YYYYMMDD) b. END (YYYYMMDD)

10. TOUR OF DUTY (X one) (Attach copy of biweekly work schedule)

FIXED

FLEXIBLE

COMPRESSED

11. TELEWORK ARRANGEMENT (X one)

REGULAR AND RECURRING SITUATIONAL

Regular and Recurring Telework Schedule: Number of days per Week or Pay Period

Days of the Week (e.g., Mon, Wed, Thurs)

All employees who are authorized to telework on a Regular and Recurring or Situational basis to include emergency situations shall have a telework 

agreement in place. 

12. CONTINUITY OF OPERATIONS DURING EMERGENCY SITUATIONS 

 

Employee is expected to telework for the duration of an emergency pursuant to: 

1) Component policy; 2) a pandemic; 3) when the regular worksite is closed or closed to the public due to natural or manmade emergency 

situations (e.g., snowstorm, hurricane, act of terrorism, etc.); or 4) when Government offices are open with the option for unscheduled telework 

when weather conditions make commuting hazardous, or similar circumstances compromise employee safety. Employees unable to work due to 

personal situations (e.g., illness or dependent care responsibilities), must take appropriate leave (e.g., annual or sick). If the worksite is closed or 

closed to the public, the employee may be granted administrative leave, on a case-by-case basis, when other circumstances (e.g., power failure) 

prevent the employee from working at the telework site. Managers will include a description of emergency duties with this agreement if emergency 

duties are different from the employee's prescribed duties and responsibilities.

13. SUPERVISOR OR AUTHORIZED MANAGEMENT OFFICIAL (Name and Signature)

I also verify that I have completed approved telework training.

14. DATE (YYYYMMDD)

15. EMPLOYEE SIGNATURE I also verify that I have completed approved telework training. 16. DATE (YYYYMMDD)
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SECTION II - SAFETY CHECKLIST

SAFETY FEATURE (X) YES NO

1. Temperature, ventilation, lighting and noise levels are adequate for maintaining a home office.

2. Electrical equipment is free of recognized hazards that would cause physical harm (frayed, exposed, or loose 

wires; loose fixtures, bare conductors; etc.).

3. Electrical system allows for grounding of electrical equipment (three-prong receptacles). 

4. Office (including doorways) is free of obstructions to permit visibility and movement. 

5. File cabinets and storage are arranged so drawers and doors do not enter into walkways. 

6. Phone lines, electrical cords, and surge protectors are secured under a desk or alongside a baseboard.

7. If material containing asbestos is present, it is in good condition. 

8. Office space is free of excessive amount of combustibles, floors are in good repair, and carpets are well 

secured. 

I verify that this safety checklist is accurate and that my home office is a reasonably safe place to work. 

9. EMPLOYEE SIGNATURE 10. DATE (YYYYMMDD)
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SECTION III - TECHNOLOGY/EQUIPMENT

(1) 

TECHNOLOGY/EQUIPMENT 

(Indicate all that apply)

(2) 

REQUIREMENT 

(Y or N)

(3) 

OWNERSHIP: AGENCY 

OR PERSONAL 

(A or P)

(4) 

REIMBURSEMENT 

BY COMPONENT 

(Y or N)

 1. COMPUTER EQUIPMENT

a. LAPTOP

b. DESKTOP

c. PDA

d. OTHER

 2. ACCESS

a. IPASS/VPN ACCOUNT

b. CITRIX - WEB ACCESS

c. OTHER

3. CONNECTIVITY

a. DIAL-IN

b. BROADBAND

4. REQUIRED ACCESS CAPABILITIES

a. SHARED DRIVES (e.g., H or P Drive)

b. EMAIL

c. COMPONENT INTRANET

d. OTHER APPLICATIONS:

5. OTHER EQUIPMENT/SUPPLIES

a. COPIER

b. SCANNER

c. PRINTER

d. FAX MACHINE

e. CELL PHONE

f. PAPER SUPPLIES

g. OTHER

6. SUPERVISOR'S SIGNATURE 7. DATE (YYYYMMDD)

8. EMPLOYEE SIGNATURE 9. DATE (YYYYMMDD)
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SECTION IV - NOTICE OF TELEWORK ARRANGEMENT CANCELLATION 

(Complete this section when the telework agreement is cancelled.)

1. CANCELLATION DATE (YYYYMMDD) 2. INITIATED BY (X one)

EMPLOYEE MANAGEMENT

3. REASON(S) FOR CANCELLATION

4. GOVERNMENT-FURNISHED EQUIPMENT/PROPERTY RETURNED LIST 

PROPERTY AND DATE OF RETURN: YES NO

5. SUPERVISOR'S SIGNATURE 6. DATE (YYYYMMDD)

7. EMPLOYEE SIGNATURE 8. DATE (YYYYMMDD)