Employee Termination Clearance Form

I have attached Employee Termination Clearance Form in Excel Format.

SEPARATION CLEARANCE CHECKLIST
Employee Name Employee Code:
Department
Review and Complete this checklist and return to you supervisor or Department Head Employee
Initials & Date		 Authorized Rep
Initials & Date
1 Access/ ID Card? Yes Not Applicable
2 Office Keys (e.g. desk, drawers, filling cabinets etc) Yes Not Applicable
3 Office Equipments (e.g. computer/ laptop, calculator etc) Yes Not Applicable
4 Mobile? SIM card? Mobile Charger? Yes Not Applicable
5 Vehicles/ Transport Equipments? Yes Not Applicable
6 Tools? Yes Not Applicable
7 Uniform? Yes Not Applicable
8 Library/ Bookstore Materials? Yes Not Applicable
9 Manuals and books? Yes Not Applicable
10 Visiting Cards? Yes Not Applicable
11 Corporate credit card? Yes Not Applicable
Have you also
1 Given your Forwarding Address to HR department for correspondence? Yes Not Applicable
2 Handed over all the details of the account/ work you were handling to your Supervisor? Yes Not Applicable
3 Submitted your income tax related papers? Yes Not Applicable
4 Attended your exit interview to offer confidential comments? Yes Not Applicable
Have You? (Supervisor/ Department Representative and HR Representative) Authorized Rep
Initials & Date		 HR Rep
Initials & Date
1 Review departing employee’s work assignment and collect any applicable confidential and work-related information or materials? Yes Not Applicable
2 Terminated individual’s email id / rights to access IT systems? Yes Not Applicable
3 Terminated the mobile number and destroyed the SIM card? Yes Not Applicable
4 Terminate the individual’s signature authority on bank accounts? Yes Not Applicable
5 Collected from the individual all assets listed on Asset Tracking Form? Yes Not Applicable
6 Wage-in-kind adjustment accounted for? Yes Not Applicable
7 Forwarded materials as appropriate to HR? Yes Not Applicable
8 Cancelled any training scheduled but not yet incurred? Yes Not Applicable
9 Cancelled any travel scheduled but not yet incurred? Yes Not Applicable
10 Submitted appropriate seperation action(s) thorugh HR system prior to the payroll cutoff deadline for the final pay date? Yes Not Applicable
11 Set up an Exit Interview for the individual with HR? Yes Not Applicable
12 Credit Card- Check pending expenses for clearance if any- return the card to Accounts? Yes Not Applicable
13 Forwarded Manpower Requisition form and discussed with HR for continuation of business/ project? Yes Not Applicable
14 Details of any recoveries to be made for training? Yes Not Applicable
HEAD OF THE DEPARTMENT
My Signature certifies that all seperation requirements for the individual have been satisfied.
Name & Designation Signature Date
To: HR Information Management
FOR HR USE ONLY
Employee date of joining:
Employee date of resignation:
Employee date of leaving:
Exit Interview Conducted on:
Salary released on:
Certificate released on:
Remarks:
Name & Designation Signature Date

 

Click Here To Download Seprance Clearance Checklist

Search Sample Formats:

Related Sample Formats:

  1. Employee Separation Clearance Checklist in Word