Flexible Workspace Request Form (Word)

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NYU Steinhardt Flexible Workspace Request
NYU Steinhardt provides flexible work arrangements, when it is reasonable and practical to do
so, to help employees balance personal and professional responsibilities while ensuring
institutional and department goals are met.
Administrators who have completed at least one year at the Steinhardt School, and whose job
duties and responsibilities are appropriate to a flexible work arrangement are eligible. Full time
administrators who teach outside established work hours are ineligible.
It shall be the responsibility of both the Supervisor and the Employee to consider, assess, and
evaluate the potential business implications of implementing flexible work arrangements, the
potential impact on costs, supervision, staff, services and the department’s ability to meet its
objectives. Nothing in this policy is intended to alter an employee’s responsibilities, which are
determined by an employee’s supervisor.
Responsibilities of Employees:
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Fully understand the nature and impact of the flexible work arrangement
Report to work on-site, when requested by your Supervisor
Maintain a continuing dialogue with your Supervisor
Attend regular meetings with your Supervisor to review and confirm expectations and
performance targets
Report daily on progress when working from remote location
Communicate to colleagues flexible workspace arrangement (i.e. post notice on office
door or in cubicle)
______Employee Initial
______Supervisor Initial
Responsibilities of Supervisors:
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Maximize resources and utilize staff talents
Be prepared to manage the work under the conditions of the arrangement
Personally model balanced work practices
Focus on individual’s suitability to work in a flexible work arrangement
Measure performance by results rather than through direct observation
Hold regular meetings with your Employee to review and confirm clearly stated
expectations and performance targets, recognize Employee’s contributions,
achievements and address any problems/obstacles Employee may be experiencing
Change the plan if it is not serving the unit’s needs
______Employee Initial
______Supervisor Initial
NOTE: ALL FLEXIBLE WORK AGREEMENTS ARE REVOCABLE AT ANY TIME
Employee Information
Name (Last, First): Click here to enter text.
NetID: Click here to enter text.
Department: Click here to enter text.
Office Address: Click here to enter text.
Office Phone Number: Click here to enter text.
NYU email: Click here to enter text.
Supervisor Information
Name (Last, First): Click here to enter text.
Office Address: Click here to enter text.
Office Phone Number: Click here to enter
text.
NYU email: Click here to enter text.
Proposed Flexible Workplace arrangement (employee to fill in based on
discussion with supervisor) Please include proposed location, day(s), hours to be
worked, as well as specific tasks/projects that you will work on the flex workplace.
Click here to enter text.
Supervisor’s Comments (to be filled in by supervisor after discussing proposal
with employee) Please comment upon employee’s ability to work remotely and
independently; list any supporting factors of this agreement; and include the
agreed upon reporting schedule.
Click here to enter text.
Proposed Start Date of Flexible Workplace arrangement: Click here to enter text.
Proposed End Date of Flexible Workplace arrangement (if applicable): Click here to
enter text.
Date of One Month Trial Review: Click here to enter text.
Date of Three Month Review: Click here to enter text.
Employee Signature and Date: _________________________________________
Supervisor Signature and Date: ________________________________________
Department Administrator Signature and Date: ___________________________
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