Posts tagged "Clearance"

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

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Posted by Hrformats - September 13, 2012 at 4:19 AM

Categories: HR   Tags: , ,

Employee Separation Clearance Checklist in Word

I have attached employee separation clearance checklist in word format.

SEPARATION CLEARANCE

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

CHECKLIST, page 2

 

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:

               My signature certifies that all separation requirements for the individual have been satisfied.

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

Search Sample Formats:

Be the first to comment - What do you think?
Posted by Hrformats - September 13, 2012 at 4:16 AM

Categories: HR   Tags: , ,