DOLE TWA Report Form (version 0 - as of 26 March 2019)
Republic of the Philippines
                                                                  Department of Labor and Employment
                                                                           Intramuros, Manila
                                     REPORT ON THE ADOPTION OF TELECOMMUTING WORK ARRANGEMENT (TWA)
1. Name of establishment:                                2. Address:                                                     3. Contact details
                                                                                                                         3.1 Name of contact person and designation:
                                                                                                                         3.2 Telephone no.:
4. Nature of business:                                   5. Period of       5.1 Date start:                              3.3 Mobile no.:
                                                            coverage on
                                                            the adoption
                                                                            5.2 Date end:                                3.4 E-mail address:
                                                            of TWA
6. Total no. of employees in the establishment:                                             7. Total no. of employees under TWA:
6.1 Male:                                     6.2 Female:                                   7.1 Male:                                        7.2 Female:
   6.1.a          6.1.b            6.1.c         6.2.a         6.2.b          6.2.c            7.1.a          7.1.b            7.1.c            7.2.a      7.2.b           7.2.c
 Solo Parent      PWD        Senior Citizen    Solo Parent     PWD         Senior Citizen    Solo Parent      PWD           Senior Citizen   Solo Parent   PWD         Senior Citizen
8. Implications      8.1 On employees:
   of the
   adopted
   scheme
   (describe         8.2 On employer:
   briefly)
9. The scheme is agreed upon voluntarily by both parties, employer and employees.
9.1 Employer’s    9.1.a Signature:                                       9.2 Employee’s                    9.2.a Signature:
representative                                                           representative
                     9.1.b Full name:                                                                      9.2.b Full name:
                     9.1.c Date:                                                                           9.2.c Date: