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Flextime Evaluation Form

May 23, 2002
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Related Topics: Scheduling, Featured Article, Compensation, Benefits
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Flextime Request

Name: ___________Title: ___________Date: ___________
Exempt: yes   noDept: ___________Mngr: ___________

NOTE: The person requesting flextime isresponsible for securing coverage if needed.

Flexibility Requested: hours location  Dates: ___________

Explain (incl. datesand change from current schedule):

 

 

How will this enhance your ability to performyour job?

 

 

Team Involvement Needed: yes no  Team Involved? yes  no
What coverage is needed?

 

 

What work will be done?

 

 

Who will benefit from work done?

 

 

Approved By:____________________________  Date: __________
- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - -

COMPLETE AFTER FLEXTIME HAS BEEN UTILIZED

How did flextime enhance your ability to getyour job done?

 

 

Did you accomplish the specific workdescribed in your request?

 

 

How was it an improvement for any of thefollowing:
· USER·SUPERVISOR· OTHER
·EXTERNAL CUSTOMER·INTERNAL CUSTOMER

Explain:

 

 

Were you satisfied with the process? Why orwhy not?

 

 

Does this enhance your job satisfaction?Explain:

 

 

Did customers express satisfaction with workperformed?

 

Did this enhance your ability to perform yourjob? Explain:

 

 

Was the customer: internal  external

TO BE COMPLETED BY SUPERVISOR

Do you agree with the evaluation?yes  no
Could this use of flextime be improved?Explain:

 

 

ATTACH ANY ADDITIONAL COMMENTS AND RETURNTO HUMAN RESOURCES

Reprinted withpermission from "ExhibitBook of Personnel Forms," Watson Wyatt Data Services. For moreinformation, visit www.wwdssurveys.comor call 201/843-1177

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