COMPANY NAME

Employee Name                                                                                               Term Date:                                          

Checklist completed by:                                                                                    Date:                                                     

TERMINATION CHECKLIST

Following is a checklist of items that must be completed prior to or on the last day with COMPANY:

I.         General — Manager and Human Resources

____   Voluntary — Give written resignation letter to supervisor with a copy to Human Resources

____   Involuntary — Statement and/or documentation to the file regarding termination

____   Conduct the exit interview

____   Notify Network Administrator to terminate access to computer, e-mail, voice mail, etc.

II.        Items to Return, where applicable

____   Office keys/cards (front door/building, office, gym facility)

____   Corporate credit card name and #                                                      

____   Parking pass or metro pass

____   Equipment/property: (Employee Handbook, software, cell phone, laptop, etc.)

List items:                                                                                                                                                                            

III.      Payroll

____   Obtain forwarding address (for W-2)

____   Note any outstanding expenses (expense checks, advances, relocation expenses):

____   Review leave reconciliation (vacation/PTO)

____   Obtain final signed timesheet and inform when final paycheck would be sent

____   Process status change/payroll form and send to Payroll

IV.      Benefits — Human Resources

____   Notify of COBRA continuation of health, dental

____   Provide and/or mail COBRA letter (copy for file)

____   Provide 401(k) withdrawal distribution forms with special tax notice

____   Request pension calculation, if applicable

____   Send pension paperwork to employee

____   Request pension withdrawal

____   Explain company policy on employment verification

(Co. only verifies dates of employment, position and with signed authorization,  salary will be confirmed. Unemployment Office is the only agency that  Company may provide reason for separation.)

V.        Benefits — Human Resources

____   Notify carriers of termination:

Medical                                                                                                                                    

Dental                                                                                                                                         

Life/disability                                                                                                                          

FSA                                                                                                                                           

401(k)                                                                                                                                       

Other                                                                                                                                         

____   Review employee’s personnel and confidential files, and transfer files to  inactive status

____   Update I-9 form and transfer to inactive status

VI.      Other Actions

© Copyright – Employers Associates Inc. 2011