Employee name: _______________________ Department:_________________
Termination date: _______________________
Type of Termination
☐ Voluntary:
☐ Received employee's resignation letter. (If verbal resignation, provided employee with a written confirmation of resignation).
☐ Exit interview scheduled. ☐ Exit interview completed.
☐ Involuntary:
☐ Provided employee with termination letter.
☐ Provided employee with severance agreement if eligible.
☐ Received signed severance agreement.
☐ Provided employee with WARN notice (if applicable).
Benefits
☐ Provided employee with termination/continuation of employment insurance benefits information (COBRA, life insurance, supplemental insurance, etc.)
☐ Checked FSA/HSA participation and informed employee of remaining funds and reimbursement deadlines, if applicable.
☐ Checked dependent care FSA participation and informed employee of remaining funds and reimbursement deadlines, if applicable.
☐ Checked PTO balance and informed employee of any remaining PTO and how it will be processed at termination of employment.
☐ Informed employee about retirement plan account options.
Compensation
☐ Provided notice of policy regarding any outstanding balances for money owed to company (e.g., educational loans/pay advances).
☐ Notified payroll department to process final paycheck.
☐ Informed payroll of any unused but earned PTO amounts due to the employee.
☐ Notified payroll to process severance pay and whether lump sum or salary continuation (if applicable).
Contracts/Legal
☐ Provided written notice to employee of any legal obligations that continue post-employment (e.g., noncompete/confidentiality agreements/employment contracts).
Immigration
☐ Notified company immigration attorney of termination if employee is on a temporary work visa.
Records
☐ Pulled personnel file to be stored with terminated employee files.
☐ Pulled Form I-9 to be stored with terminated employees' I-9s.
☐ Obtained written authorization from employee to respond to employment verification requests.
Information Technology
☐ Disabled e-mail account.
☐ Removed employee's name from e-mail group distribution lists; internal/office phone list; website and building directories.
☐ Disabled computer access.
☐ Disabled phone extension.
☐ Disabled voicemail.
Facilities/Office Manager
☐ Disabled security codes, if necessary.
☐ Changed office mailbox.
☐ Cleaned work area and removed personal belongings.
☐ Collected the following items:
☐ Keys (☐ office ☐ building ☐ desk ☐ file cabinets ☐ other)
☐ ID card
☐ Building access card
☐ Business cards
☐ Nameplate
☐ Name badge
☐ Company cell phone
☐ Laptop
☐ Uniforms
☐ Tools
☐ Other _______________________
☐ Other _______________________
Form completed by:____________________________________ Date: _________________
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