Accepted/Denial request Questionnaire

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Please answer these questions if you applied for a remote from home assisnment.

Last Name *

First Name *

Did you apply for a Remote from Home Assignment? *

Yes

What was the result of your request? *

Accepted

Denied

If you were denied, what was the reason from HR? *

What Tier did you apply under? *

Tier 1 (Individuals with disabilities under the ADA, including pregnant employees)

Tier 2 (Individuals who are personally medically identified as at heightened risk from COVID-19 as defined by the CDC)

Tier 3 (Individuals who are living in a household with someone who is personally medically identified as at heightened risk from COVID-19 as defined by the CDC)

Tier 4 (Individuals who would be eligible for federal COVID-related childcare leave with sufficient documentation)

Tier 5 (All other employees)

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