Sample Remote Work Request Forms

Below are three sample remote work request forms. They can be customized by an employer to be used as part of a return-to-work plan.

• The Remote Work Request sample form enables an employee to request approval for remote work. Click here to download. 
  
• The Remote Work Extension Request sample form enables an employee to request an extension for working remotely. Click here to download. 
  
• The Hybrid Work Request sample form enables an employee to request approval for a hybrid or flexible work schedule. Click here to download.