HTML Preview Employee Termination Checklist Form page number 1.
Employee Termination Checklist
Employee Name: __________________________________________________________________________________
Supervisor:_______________________ Dept: ________________ Account #: ________________________________
Forwarding Address (if changed):
________________________________________________________________________________________________
Phone number: Day: ( ) __ __ __ - __ __ __ __ Eve: ( ) __ __ __ - __ __ __ __
Last day worked: ________________
Instructions: Please put your initials and the date next to the action that has been taken.
Voluntary Termination Involuntary Termination (Steps to follow)
_________ Obtain resignation in writing from Employee __________ a) Corrective action followed (if applicable)
__________ b) Explanation provided to employee
Other (Death, Military)Reason _______________ __________ c) Human Resources reviewed information
_________ Received supporting documentation __________ d) Letter of termination including reasons
Review With Employee Collect
_________Effective Date of Termination __________ Key Fob
_________Final wages __________ All keys (locker, bldg, desk,
cabinets, etc)
Check to be direct deposited __________ Final Timesheet
Check to be picked up Where?_______
Check to be mailed Where?_______ __________ Cellular phones
__________ iPad
_________Benefit pay (if applicable) __________ Laptop computer
Accrued time off __________ Parking tag
When received
__________ ID card
_________ Benefits information summary __________ Reference/Training/Manuals
_________ Rehire eligibility: __________ Any proprietary materials/
Y N property
_________ How references will be handled
_________ Subsequent access to premises
Give to Employee (Optional) Cancel
_________ Exit Interview __________ Computer access
_________ Benefits information (COBRA, etc) __________ TSIS
_________ Contact information for HR __________ Remove from phone list – dept.
__________ Cancel email
Other __________ Benefits (CHS)
_________ Clean work area, remove personal belongings __________ Direct Deposit
_________ Process Termination (HR, Payroll) __________ Lunch Account
Notes:
Signature of Supervisor and Date:
_____________________________________________________________________
Supervisor should complete form and notify other areas as appropriate to ensure that all parts of the
checklist are completed. Return form to HR when complete.