Fill and Sign the Termination Checklist Form

Exit/Termination Checklist Supervisor’s Checklist for Termination of Employees Employee Information Name:       E-Mail:       Department:       Phone:       Campus Address:       Supervisor:       Supervisor’s Phone:       Date Hired:       Date Terminated:       Note to Supervisor If this is an involuntary termination, your goals must be to:  Reduce legal risks for the company  Retain employee’s dignity  Protect the company’s reputation  Minimize disruptions of the normal functioning department Notify Human Resources (       -       -       ) immediately of all involuntary terminations. In order to process voluntary and involuntary terminations, please place a check by the appropriate reason(s). Voluntary Involuntary Accepted Position Outside Company Position Eliminated Dissatisfied with Working Conditions Lack of Funding Relocation Seasonal Funding Health Lapse of Funding Education Violation of Company Rules Other Personal Excessive Absence/Lateness Military Service Failure to Perform Duties Transferred to another Department Release Unable to Perform Satisfactorily Retired: Age 65 and over Other Retired: Before 65 Disability Layoff/Retirement Deceased Other Benefits Time / Leave record Number of unused vacation days:       Severance pay: $       Counseling Continuation of health insurance: Direct employee to H.R. Administrator Employment: Outplacement services: Exit interview schedule appointment University Property (Collect if applicable) Cellular Telephone, Beeper Keys Office (Change locks if necessary) ID Cards Laptop, PDA Collect/Cancel Corporate credit cards Collect outstanding travel allowances Close/collect any Petty Cash accounts Forward telephone calls Telecommunications (cancel track #) Safeguard desktop computer Manuals/Texts and Lab equipment information