Agency Contact Information:

Name: ___________________________________________________________

Address: ________________________________________________________

Phone #: ________________________ Email ___________

1. Total Number of Employees in Agency:  ______
   
   
2. Total Number of Employees Eligible to Telework  ______
   
   
3. Total Number of Employees Teleworking  ______
   
   
   Regular/Regularly Scheduled  _____
   
   Episodic/AdHoc/Situational _____
   
   Medical _____
   
   Other  __________   (specify)______________________
   
   
   3 (a). Number of Teleworking within the Washington, D.C. Metro Area  ______
   
   3 (b). Number of Teleworking outside the Washington, D.C. Metro Area  ______
   
   
4. Form of Telework Policy(check all that apply):
   
   Written (handbook, memorandum, letter, etc.) ______
   Informal _____
   
   
5. Scope of Telework Policy (check all that apply):
   
   Agency-wide _____
   Headquarters _____
   Regional _____
   Bureaus/Departmental/Subdivision _____
   
   
6. Does your agency policy allow the following categories of employees to telework?
   (Check all that apply):
   
   Executives _____
   Managers _____
   Supervisors _____
   Temporary _____
   Employess on AWS _____
   Others _____  (specify): _______________
   
   
7. Types of Telework Arrangements Permitted by Agency Policy (check all that apply):
   
   Regular/Regularly Scheduled  ______
   Episodic/AdHoc/Situational _____
   Medical _____
   
   
8. Number of Employees on an Alternative Work Schedule _____
   
   
9. Number of Employees on a Compressed Work Schedule _____
   
   
10. What actions has your agency taken to increase telework particpants since our April 2001 survey?
    _______________________________________________________________
    _______________________________________________________________
    _______________________________________________________________
    
    
11. What actions has your agency taken to overcome barriers that were identified in our April 2001 survey to increase telework participation?
    ________________________________________________________________
    ________________________________________________________________
    ________________________________________________________________