Sample Telecommuting Screening and Evaluation Form

January 1, 2000
Critical components of your telecommuting program are the screening and evaluation processes. It is imperative to assess what impact telecommuting will have or has had on the organization.

The checklists and questionnaires below can be used to generate screening and evaluation forms for use by telecommuters, managers, and control groups. If they are administered to the participants before the program is implemented and again at the end of the pilot program, the two surveys can be compared and analyzed.


Have you ever telecommuted?

How often do you expect to telecommute?

What type of work will be done while telecommuting?



___Auditing reports

___Batch work


___Computer conferencing

___Conducting business by telephone

___Contract preparation/ monitoring

___Data analysis

___Data entry

___Data manipulation

___Data processing

___Data programming


___Field visits

Maintaining databases

___Meeting with clients


___Project-oriented work/ management




___Sending/receiving electronic mail

___Spreadsheet analysis

___Support activities



___Using a computer

___Word processing





Do you have a room or an area at home to dedicate to telecommuting?

What equipment/services do you need to successfully telecommute? What equipment do you currently have?



Currently Have

Additional phone line



Answering machine






Calling card









Facsimile machine



File cabinet



Internet access


















Voice mail








Do you have a separate telephone line at your residence for work-related calling?

Do you use residence or business telephone services for your work-related calling?

Which of the following special telephone services do you use in your work-related calling?

___Conference calls

___Call forwarding

___Voice mail

___Call waiting

___Three-way calling


What additional communication equipment or services would improve your productivity?



___Voice mail




___Internet services


Would you use your telephone more if it cost you less to make the calls?

Estimate the monthly cost of work-related telephone usage for local and long-distance services.

How many hours each day do you use a computer?

Do you use a modem for computer communications?

How long is your average online session?

Approximately how many online sessions do you have each day?

Would you use computer communications more often if the communications cost less?



How do you usually travel to and from work?

___Drive alone



___Public transportation





How many miles do you travel to work each day (round trip)?

How long does it take you to get to and from work (round trip)?

What time of day do you arrive at work?

What time of day do you leave work?



Please indicate, by degree, the extent to which telecommuting has changed your life (Greatly Increased, Increased, Neither Increased nor Decreased, Decreased, etc.):


  • Time spent working
  • Effectiveness of working relationships at the office (communication, coordination)
  • Absence from the office
  • Quality of work
  • Amount of work done at home


  • Satisfaction with work
  • Morale
  • Professional/personal balance
  • Autonomy in carrying out assignments



Assess the following issues by degree, as above:

  • Communication with co-workers
  • Work-related stress
  • Control over work
  • Isolation
  • Sense of belonging to the organization
  • Responsibility for work
  • Opportunity for promotion or career advancement
  • Desire to look for a different job
  • Expectations of co-workers
  • Expectations of the telecommuter
  • Quality of supervision
  • Trust between management and telecommuter



The following factors should be included in your screening/evaluation surveys for management, supervisors, and control groups, and assessed by degree, as above:

  • Communications between management and telecommuter
  • Management attitude toward telecommuting
  • Employee attitude toward telecommuting
  • Impact of telecommuting on the organization's competitive edge
  • Time spent managing telecommuters as opposed to office employees
  • Nervousness regarding telecommuter output
  • Negative attitude toward non-telecommuters
  • Difficulty scheduling meetings
  • Objective-setting skills


Excerpted with permission from the Journal of AHIMA, February 1999.