Flexible Working Decision Form

1.	If you have conducted a flexible working meeting in accordance with the Council’s Flexible Working Policy to consider an employee’s flexible working application, please complete this form to notify the employee of your decision. 
2.	If you have approved the employee’s request to work flexibly, please complete Part A and B of this form. You will also need to complete a change form (e.g. for changes of hours of work, or flexible working arrangements involving changes in payment).
3.	If you have declined the employee’s request to work flexibly and/or are able to agree alternative flexible working arrangements, please complete Part A and C of this form.
4.	Please refer to the Flexible Working Policy and the associated Guidelines for Managers when completing this form.  Further advice is available from the HR team.
5.	You must give the employee the completed form as soon as possible from receipt of the flexible working application.  If you are unable to reach a decision within 14 days, you must notify the employee of the delay.  The application process, including appeals process, must be completed within 2 months of receipt of application.
6.	You cannot refuse the application without consulting with the employee on alternatives. 

Part A – Please complete this section of the form for all employees
Dear:      	(employee’s name)	
Job title:      	Department:      	
Thank you for attending the flexible working meeting on:                          (date)	
I have considered your request to work flexibly very carefully. Either	
I am pleased to be able to confirm that I have been able to accept your flexible working application and ask you to read Part B to find out details of the new arrangements  OR 	
I regret that I have been unable to agree to your flexible working application.  Please read Part C of the form for the reasons for this and for information on your right to appeal my decision. 	

Part B – Details of your approved flexible working application
Your new flexible working pattern will begin from:                                   (date)	
Your new flexible working arrangements will be as follows:      	
(Please tick one of the following options) 	Yes	
Your flexible working arrangement will be on a permanent basis		
Your new flexible working arrangements are agreed for a trial period which will last until:
       (date) at which time they will be reviewed and if successful, made permanent.  	
	
I have agreed to the flexible working arrangements on a fixed-term basis until: 
       (date) for the following reasons:      . 	
	
If you have any questions about the information provided on this form or your new working arrangements, please discuss them with me as soon as possible	
Name:      	Date:     	
Signature: 		

Part C: The Reasons why I declined your flexible working application

I am sorry but I am unable to accommodate your request for the following organisational reason(s)	
(Please tick at least one of the following) 	Yes	
i.  Burden of additional costs		
ii. Detrimental effect on ability to meet customer demand		
iii.  Inability to reorganise work among existing staff 		
iv.  Inability to recruit additional staff		
v.  Detrimental impact on quality		
vi.  Detrimental impact on performance		
vii.  Insufficiency of work during the periods you propose to work		
viii.  Planned structural changes. 		
The organisational reason(s) apply in the circumstances because:      

	
(If you are typing this form, the box will expand.  If handwriting this form, please continue on a separate sheet if necessary). 

	
(Please tick one of the following if applicable) 	Yes 	
I was also unable to agree to any of the alternative working arrangements we discussed at the meeting because of the following reason(s):      		
Although I was unable to accommodate your original request, I am pleased to be able to offer you the following alternative working arrangements:      

(Please give full details of the alternative arrangements & the reasons why you can agree to them).		
If you wish to accept these alternative arrangements, please can you write to me to confirm your acceptance.   		

Appeal	
You have the right to appeal against my decision.  If you wish to appeal, please	
1. 	Complete the Appeal form explaining the reasons for your appeal and giving details of your availability for an appeal hearing.  The Appeal form is available on the HR Microsite	
2. 	Send the completed Appeal form to the Manager of your Manager within 14 days of receipt of this form.	
On receipt of your Appeal form, the appropriate Manager will invite you to an appeal meeting.  	
Further information on the appeal process can be found in Flexible Working – Guidance for Employees.

(Manager’s details)

Name:      	Date:       	
Signature: 	
.