Termination Checklist
Employee Name:________________________________________ Termination Date: ____/____/____
Position:__________________________________ Department: _____________________________
Reason for Termination:______________________________________________________________
TERMINATION CHECKLIST:
Exit Interview Date _____/_____/_____
Exit Interview Notes in File
Resignation Letter Received (if applicable)
Open Requisition Completed
Forwarding Address:
_______________________________________________________________________________
Street City State Zip
EMPLOYER PROPERTY
Office Keys City
Cell phone Yes No Not Applicable
Pager Yes No Not Applicable
Credit Card
Laptop
Other Yes No Not Applicable
ACCESS CANCELLATION
Building Alarm Code Cancelled
Disconnect Computer Login
Email Address Removed from Staff List
Desk/workspace Area Cleaned Out
Employee Voicemail Removed
Name Removed from Time Clock if Applicable
Name Removed from Staff Phone List
BENEFITS
Life Insurance Cancelled
Does Employee Want COBRA Yes No
COBRA Notification Mailed Yes No
Health Insurance Yes No
Dental Insurance
Retirement Contributions Stopped Yes No
FINAL PAY
Final Hours Calculated _________
Final Paycheck
Vacation Payout
Checklist Completed By: ____________________________________________Date: ____/____/____