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Download DA Form HQDA6, also known as Telework Agreement Headquarters, Department Of The Army. This form is used to ensure safety for systems already in place. It will also be used to assist in management of technological vulnerabilities and risks.

How To Fill-In

Step 1 – Employee Information – Complete the blocks for administrative use and scheduling as follows:

  • 1. Name (Last, First, Middle Initial format)
  • 2. Job Title
  • 3. Pay Plan/Series
  • 4. Organization
  • 5. Traditional Official Work Site
  • 6. Type Of Telework Empoyee Requests (read and select appropriate box)

Step 2 – Block 7. – Telework Implementation Dates:

  • 7.a. – Date Telework Begings (yyyy/mm/dd format)
  • b. – Date Telework Ends  (yyyy/mm/dd format)
  • (unless terminated, re-validation usually occurs in 12 months)

Step 3 – Block 8. – The Employee’s Alternative Work Site Is: (make a selection from the three boxes provided)

  • 8.a. – Alternative Worksite Address
  • b. – Phone
  • c. – Fax
  • d. – Email

Step 4 – Block 9. – Number Of Days The Employee Will Telework:

  • Specify Number of Days

Step 5 – Block 10. – Telework Tour Of Duty (ie: 8:30 am to 5:00 pm)

  • From -
  • To -

Step 6 – Block 11. – Days Of Week Employee Teleworks (check the boxes that would apply to your schedule Monday through Friday)

Step 7 – Block 12. – Complete your committed work schedule Sunday through Saturday:

  • 12.a. – Day
  • b. Week One
  • c. Week Two
  • d. Fixed (F) Or Alternative (A)
  • e. Flexible (FWS) Or Compressed (CSW)
  • f. Duty Hours
  • g. Work Schedule Comments

Step 8 –  Block 13. – Safety Checklist – This checklist is used in assessing the overall safety of the alternative worksite

  • a. Workplace Environment (read each statement in each block and answer by checking yes or no in the boxes
  • b. Computer Workstation – Read each item in section 13.b. and respond by checking yes or no in the boxes

Step 9 – Block 14. Other Requirements/Comments On Environment And Safety Of  Alternative Worksite- (place comments in the block provided.

Step 10 – Technology/Equipment Requirements For Alternative Worksite – See each selection and answer to the selection with Yes or No and Agency or Personal-

  • Computer Equipment
  • Access
  • Connectivity
  • Required Access Capabilities
  • Other Equipment/Supplies

Step 11 – Block 16. – IMO Certification- Read the statement in block 16. – If agreed:

  • a. IMO Signature
  • b. Date (yyyy/mm/dd format)

Step 12 – Block 17. – Signatures-

 

  • Employee Verfification- Read the information in block 17, if agreed:
  • a. Employee Signature
  • b. Date (yyyy/mm/dd format)

Step 13 – Supervisor’s Certification and Signature – Read the information in block 18, if agreed:

  • a. Employee Signature
  • b. Date (yyyy/mm/dd format)

Step 14 – Block 19a. Approval Authority Signature- Approved/Disapproved (select the appropriate box)

Date (yyyy/mm/dd format)

These forms are fillable online or printable for manual use and/or sending.

 

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