VCOM Institutional Policy and Procedure Manual

Remote Work Request Form

Please review the VCOM Policy on Workplace Site Expectations, Requirements, and Working Remotely prior to completing this request form. Employee Name: _________________________________ Employee Title: _________________________________

Immediate Supervisor: _________________________________ Department/Division: _________________________________ 1. Duties of the Position:

________________________________________________________________________ 2265 Kraft Drive | Blacksburg, Virginia 24060 | (540) 231-4000 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 2. Schedule and Location of work to be performed remotely: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. The methods of communication and the expectations of the requestor (employee) on work product and communication with supervisors: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4. The method of oversight and communication with anyone reporting to the requestor (employee):