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
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