form template · Free download
Work From Home Request Form
A work from home request form for employees to request remote or hybrid days, with schedule, setup, and manager approval fields for a clear, documented arrangement.
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What you get
- A remote work request form covering one-off and recurring arrangements
- Proposed schedule and duration fields for clarity
- A home setup and availability confirmation checklist
- A manager approval and review section
Template preview
A preview of the structure. Download the PDF or CSV for the complete, ready-to-use version.
Employee details
- Employee name
- Department
- Manager
- Date of request
Requested arrangement
- Type— one-off day / recurring weekly / temporary period
- Requested day(s)— e.g. every Wednesday and Friday
- Start date
- End date or review date
Home setup confirmation
- I have a reliable internet connection
- I have a suitable, distraction-light workspace
- I can access all the tools and systems my role needs
- I will be reachable during agreed working hours
Manager approval
- Decision— approved / approved with changes / declined
- Agreed core hours / availability
- Review date
- Manager comments
Approval should confirm the arrangement does not reduce team coverage or output. For recurring remote work, always set a review date so the arrangement can be adjusted if needs change.
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How to use this template
- 1
Employee submits the request
Specify the days, duration, and reason, then confirm your home setup and availability.
- 2
Manager reviews
Check the arrangement fits the role and team coverage, then approve, adjust, or decline.
- 3
Set a review date
Agree a check-in point for recurring arrangements so the setup keeps working for both sides.
Frequently asked questions
What should a work from home request include?
The days requested, whether it is one-off or recurring, the reason, and confirmation of a suitable home setup. A clear request lets a manager assess coverage and approve quickly rather than going back and forth.
Should remote arrangements be reviewed?
Yes. For anything recurring, set a review date so both sides can confirm it is still working. Roles, team needs, and performance change, and a scheduled check-in avoids an arrangement quietly drifting.
Does this replace a remote work policy?
No — it complements one. The form handles individual requests; a policy sets the company-wide rules on eligibility, equipment, and security. Use the form within the framework your policy defines.