I have attached employee separation clearance checklist in word format.
CHECKLIST
Employee Name | PN[ Employee Ticket No.] |
Department |
HAVE YOU reviewed & completed the Asset Tracking Form and returned to your Supervisor or Department Rep: | Employee Initials & Date | Authorized RepInitials & Date | |||
All Keys? | q Yes q Not applicable | ||||
ID Card? | q Yes q Not applicable | ||||
Account Codes & Passes? | q Yes q Not applicable | ||||
Computer/ Info Tech Equipment? | q Yes q Not applicable | ||||
Telecommunications Equipment? Mobile? SIM card Telephone? S | q Yes q Not applicable | ||||
Vehicles / Transport Equipment? | q Yes q Not applicable | ||||
Parking Pass (to Transportation Dept)? | q Yes q Not applicable | ||||
Library / Bookstore Materials? | q Yes q Not applicable | ||||
Other Equipment & Materials? | q Yes q Not applicable | ||||
Timesheets & Leave Reports? | q Yes q Not applicable | ||||
Travel Expense Receipts & Reports? | q Yes q Not applicable | ||||
Phone / Fax Or Other Usage Logs? | q Yes q Not applicable | ||||
HAVE YOU ALSO |
|||||
Given your Forwarding Address to your HR/Payroll Rep – so you will receive your annual W-2 income tax forms, etc.? |
q Yes q Not applicable |
||||
If engaged in research as part of your job, contacted Research Administration to review research agreements, patents, intellectual property agreements, etc.? |
q Yes q Not applicable |
||||
If working in a lab environment, contacted Environmental Health & Safety regarding the handling of controlled materials such chemicals, lasers, radiation, biohazards? |
q Yes q Not applicable |
||||
Attended your exit interview – for info about benefits- continuation after separation (if applicable) and to offer confidential comments? |
q Yes q Not applicable |
||||
Do you want to donate your excess annual leave (beyond the max 240 hours payout) to a specific person currently on the Shared Leave Program? | q Yes (Contact HR for info)
q No |
HR Separation Clearance Form: 04/26/05
BACK PAGE completed by Supervisor, HR/Payroll Rep, & Dept Head à
SEPARATION CLEARANCE
Employee Name | Campus ID |
Home Department |
SUPERVISOR and/or HR / PAYROLL REP:
HAVE YOU: | Authorized RepInitials & Date | ||
Terminated the individual’s long distance access codes? | q Yes q Not applicable | ||
Terminated the individual’s access rights to all IT Systems? | q Yes q Not applicable | ||
Terminated the individual’s signature authority on bank accounts (such as Foundation accounts) | q Yes q Not applicable | ||
Collected from the individual all assets listed on Asset Tracking Form? | q Yes q Not applicable | ||
Wage-in-kind adjustments accounted for? | q Yes q Not applicable | ||
Forwarded materials as appropriate to HR? | q Yes q Not applicable | ||
Cancelled any training scheduled but not yet incurred? | q Yes q Not applicable | ||
Cancelled any travel scheduled but not yet incurred? | q Yes q Not applicable | ||
Submitted appropriate separation action(s) through HR System prior to the payroll cutoff deadline for the final pay date? | q Yes q Not applicable | ||
Set up an Exit Interview for the individual with
— HR Employee Relations
|
q Yes q Not applicable | ||
Credit Card – Check pending expenses for clearance if any – Return the card to Accounts(?) | |||
Put a “tickler” on your calendar for 1 month after the termination date to verify that all payroll transactions have cleared, and to terminate individual from the Leave System.
|
q Yes q Not applicable |
DEPARTMENT HEAD / DIRECTOR:
Dept Head/ Director SIGNATURE |
Dept Head/Director Name, Printed | Date |
A copy of this completed form should be submitted for the individual’s permanent Personnel File
TO: HR Information Management
HR Use ONLY |
|
Click Here To Download Seprance Clearance Checklist
Whenever a company announces employee training session for skills development then it is supposed to…
If you are planning to immediately resign from your job but you can have your…
If you have been invited to serve in an honorary position at any institution and…
Violating the policy of the company will not be accepted by any organization and if…
Whether it is poor performance or unprofessional behavior that you have experienced at the restaurant…
If there is retaliation that you have observed in a particular team or department then…