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Checklist of Employee Termination Action


Date:
Name:Social Security No.:
Title: Department/Location:
D/O/H:Supervisor's Name:
1.         Voluntary Resignation:
____ Resignation Ltr. Received____ Adequate Notice Given (If Not, State Circumstances Why)
2.         Involuntary Resignation/Termination:
A.   Signed and Attached:

____ Management Approval Attached ____ Separation Agreement & General Release Signed
B.   Property Returned:
____ Computer Diskettes ____ Company Handbook(s)
____ Computer Books ____ Pertinent Business Documents and All Copies
____ Computer Keys ____ Office Keys
____ Company Car ____ All Company Credit Cards
____ Company Car Keys ____ All Company Equipment
____ Employee Identification Card(s)

C.   Final Accounting:

____ Prior Expenses Submitted ____ Advances/Loans Repaid
____ COBRA Benefit Forms Completed ____ 401(k)/Pension Forms Completed
____ Accrued Vacation Pay Calculated & Paid ____ Final Paycheck Issued
D.  Exit Interview Conducted:
____ Yes ____ No
E.         Other:
 


Prepared By:
Department Head:Personnel Department;
Title/DateTitle/Date
Copyright 1998 Steven M. Sack

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