Required document that constitutes the terms and conditions of Telework between UVA Health and the designated team member.

Telework Agreement is a formal written agreement between a Manager and a Team Member to permit the Team Member to work at an Alternative Work Location (i.e., Telework) instead of the On-Site Work Location from which the Team Member would otherwise work. The Telework Agreement specifies the requirements and details of the Telework arrangement. The Telework arrangement can last for a defined period or can continue indefinitely.


Team Member

  1. Download the attached Telework Agreement Form.  
  2. Complete all fields to the best of your knowledge.
  3. Review and revise as necessary with your Manager.
  4. Initial and sign the acknowledgements.


  1. Review Team Member Telework Agreement.
  2. Discuss revisions with Team Member.
  3. Sign when complete.
  4. Send to your supervisor for their signature.
  5. Keep a signed version for your files.
  6. Send a signed version to the Team Member for their files.