{"id":7340,"date":"2012-09-13T04:19:39","date_gmt":"2012-09-13T04:19:39","guid":{"rendered":"http:\/\/www.yourhrworld.com\/formats\/?p=7340"},"modified":"2012-09-13T13:16:51","modified_gmt":"2012-09-13T13:16:51","slug":"employee-termination-clearance-form","status":"publish","type":"post","link":"https:\/\/www.yourhrworld.com\/formats\/hr\/employee-termination-clearance-form\/","title":{"rendered":"Employee Termination Clearance Form"},"content":{"rendered":"<p><strong>I have attached\u00a0Employee Termination Clearance Form in Excel Format.<br \/>\n<\/strong><\/p><div class=\"69eb924294c115e6505da44099e8df92\" data-index=\"1\" style=\"float: none; margin:10px 0 10px 0; text-align:center;\">\n<script type=\"text\/javascript\"><!--\r\ngoogle_ad_client = \"pub-0867779017855679\";\r\n\/* 300x250, created 4\/20\/11 *\/\r\ngoogle_ad_slot = \"1035864135\";\r\ngoogle_ad_width = 300;\r\ngoogle_ad_height = 250;\r\n\/\/-->\r\n<\/script>\r\n<script type=\"text\/javascript\"\r\nsrc=\"http:\/\/pagead2.googlesyndication.com\/pagead\/show_ads.js\">\r\n<\/script>\n<\/div>\n\n<table width=\"976\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<colgroup>\n<col width=\"72\" \/>\n<col width=\"430\" \/>\n<col width=\"72\" \/>\n<col width=\"114\" \/>\n<col span=\"4\" width=\"72\" \/> <\/colgroup>\n<tbody>\n<tr>\n<td colspan=\"8\" width=\"976\" height=\"40\">SEPARATION CLEARANCE CHECKLIST<\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"4\" height=\"40\">Employee Name<\/td>\n<td colspan=\"4\">Employee Code:<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"40\">Department<\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"4\" height=\"40\">Review and Complete this checklist and return to you supervisor or Department Head<\/td>\n<td colspan=\"2\" width=\"144\">Employee<br \/>\nInitials &amp; Date<\/td>\n<td colspan=\"2\" width=\"144\">Authorized Rep<br \/>\nInitials &amp; Date<\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">1<\/td>\n<td>Access\/ ID Card?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">2<\/td>\n<td>Office Keys (e.g. desk, drawers, filling cabinets etc)<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">3<\/td>\n<td>Office Equipments (e.g. computer\/ laptop, calculator etc)<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">4<\/td>\n<td>Mobile? SIM card? Mobile Charger?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">5<\/td>\n<td>Vehicles\/ Transport Equipments?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">6<\/td>\n<td>Tools?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">7<\/td>\n<td>Uniform?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">8<\/td>\n<td>Library\/ Bookstore Materials?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">9<\/td>\n<td>Manuals and books?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">10<\/td>\n<td>Visiting Cards?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">11<\/td>\n<td>Corporate credit card?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"19\">Have you also<\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"38\">1<\/td>\n<td width=\"430\">Given your <span>Forwarding Address <\/span><span>to HR department for correspondence?<\/span><\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"38\">2<\/td>\n<td width=\"430\">Handed over all the <span>details of the account\/ work<\/span><span> you were handling to your Supervisor?<\/span><\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">3<\/td>\n<td>Submitted your <span>income tax<\/span><span> related papers?<\/span><\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">4<\/td>\n<td width=\"430\">Attended your <span>exit interview<\/span><span> to offer confidential comments?<\/span><\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"4\" height=\"41\">Have You? (Supervisor\/ Department Representative and HR Representative)<\/td>\n<td colspan=\"2\" width=\"144\">Authorized Rep<br \/>\nInitials &amp; Date<\/td>\n<td colspan=\"2\" width=\"144\">HR Rep<br \/>\nInitials &amp; Date<\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"57\">1<\/td>\n<td width=\"430\">Review departing employee&#8217;s work assignment and collect any applicable confidential and work-related information or materials?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">2<\/td>\n<td width=\"430\">Terminated individual&#8217;s email id \/ rights to access IT systems?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">3<\/td>\n<td width=\"430\">Terminated the mobile number and destroyed the SIM card?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"38\">4<\/td>\n<td width=\"430\">Terminate the individual&#8217;s signature authority on bank accounts?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"38\">5<\/td>\n<td width=\"430\">Collected from the individual all assets listed on Asset Tracking Form?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">6<\/td>\n<td width=\"430\">Wage-in-kind adjustment accounted for?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">7<\/td>\n<td width=\"430\">Forwarded materials as appropriate to HR?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">8<\/td>\n<td width=\"430\">Cancelled any training scheduled but not yet incurred?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">9<\/td>\n<td width=\"430\">Cancelled any travel scheduled but not yet incurred?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"38\">10<\/td>\n<td width=\"430\">Submitted appropriate seperation action(s) thorugh HR system prior to the payroll cutoff deadline for the final pay date?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">11<\/td>\n<td width=\"430\">Set up an Exit Interview for the individual with HR?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"38\">12<\/td>\n<td width=\"430\">Credit Card- Check pending expenses for clearance if any- return the card to Accounts?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"38\">13<\/td>\n<td width=\"430\">Forwarded Manpower Requisition form and discussed with HR for continuation of business\/ project?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td align=\"right\" height=\"19\">14<\/td>\n<td>Details of any recoveries to be made for training?<\/td>\n<td>Yes<\/td>\n<td>Not Applicable<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"20\">HEAD OF THE DEPARTMENT<\/td>\n<\/tr>\n<tr>\n<td colspan=\"4\" height=\"19\">My Signature certifies that all seperation requirements for the individual have been satisfied.<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"41\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"20\">Name &amp; Designation<\/td>\n<td>Signature<\/td>\n<td><\/td>\n<td>Date<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"20\">To:<\/td>\n<td>HR Information Management<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"20\">FOR HR USE ONLY<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"19\">Employee date of joining:<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"19\">Employee date of resignation:<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"19\">Employee date of leaving:<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"19\">Exit Interview Conducted on:<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"19\">Salary released on:<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"19\">Certificate released on:<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"60\">Remarks:<\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"20\">Name &amp; Designation<\/td>\n<td>Signature<\/td>\n<td><\/td>\n<td>Date<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"19\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong><a href=\"https:\/\/www.yourhrworld.com\/formats\/wp-content\/uploads\/2012\/09\/Seprance-Clearance-Checklist2.doc\">Click Here To Download Seprance Clearance Checklist<\/a><\/strong><\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div><h4>Search Sample Formats:<\/h4><ul><li><a href=\"https:\/\/www.yourhrworld.com\/formats\/hr\/employee-termination-clearance-form\/\" title=\"termination of employment clearance form\">termination of employment clearance form<\/a><\/li><\/ul>","protected":false},"excerpt":{"rendered":"<p>I have attached\u00a0Employee 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 &amp; Date Authorized Rep Initials &amp; 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<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[45],"tags":[269,1557,1558],"class_list":["post-7340","post","type-post","status-publish","format-standard","hentry","category-hr","tag-checklist","tag-clearance","tag-seperation"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Employee Termination Clearance Form - HR Letter Formats<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.yourhrworld.com\/formats\/hr\/employee-termination-clearance-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Employee Termination Clearance Form - HR Letter Formats\" \/>\n<meta property=\"og:description\" content=\"I have attached\u00a0Employee 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 &amp; Date Authorized Rep Initials &amp; 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? 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SEPARATION CLEARANCE CHECKLIST Employee Name Employee Code: Department Review and Complete this checklist and return to you supervisor or Department Head Employee Initials &amp; Date Authorized Rep Initials &amp; 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? 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