Fill and Sign the Worksheet Termination of Employment Form

Worksheet – Termination of Employment Employee Name: ____________________________________ Date of Termination: __________________________________ Actions Done Termination Notice Meet with the employee in a private, neutral location, such as a conference room or closed office, to minimize their embarrassment or discomfort. _______ Inform the employee why they are being fired or laid off. _______ Explain when the termination will be effective. _______ If today is the employee’s last day, outline the procedures for exiting the premises. _______ If the employee will remain at the company for a set period of time, tell he/she what is expected of him/her during the transition period. _______ Give the employee a termination letter that documents his/her last day, Outlines the reasons the employee is no longer working for the company, and provides information about severance benefits and other termination details. _______ Insurance and Benefits Disclose the date that the employee’s medical, dental, vision, life and long-term disability insurance coverage will end. _______ Explain COBRA, the federal act that provides employees who experience a “qualifying event” (such as a termination) with the right to continue their current group insurance coverage. _______ Give the employee a written statement that explains when their benefits will terminate, outlines COBRA law, lists monthly premiums and provides enrollment information. _______ Provide a closing statement with information about the company’s stock option, profit sharing and/or employee stock-ownership program. The statement should show how many shares the employee has vested, the price per share, and the deadline for exercising the shares. _______ Give the employee documentation about their 401(k) or retirement savings plan. Make sure it spells out when company contributions to the plan will end, explains rollover options and contains contact information for the plan administrator. _______ Paycheck, PTO Payout and Severance If today is the employee’s last day, give him/her the final paycheck along with a check for accrued vacation or paid time off (PTO). _______ Discuss any severance the employee will receive and explain how it will be paid out. _______ Severance Pay and General Release agreement offered. _______ Give the employee a letter that explains the terms of the severance package . _______ Company Owned Equipment Returned Computer and Company software. _______ Company cellular phone. _______ Company credit card. _______ Employee identification card. _______ Building/office keys and access cards. _______ Parking permit or garage key. _______ Uniforms Company vehicle. _______ Have the employee sign a document that states that he/she has returned all company property. _______ Expense and Transition Reports Instruct the employee to complete a final expense report and submit it on or before his/her last day. _______ If the employee will remain at the company for a set period of time, ask he/she to provide a transition report that details the projects they are working on. _______ Exit Interview and Employee Assistance Conduct an exit interview (if appropriate) to learn from the employee’s experience at the company. _______ Ask the employee if they have any questions or final comments. _______ Discuss any outplacement services or employee assistance the company would offer. _______ Exit interview prepared. _______ Exit interview given. _______ Office Operations Discontinue the employee’s email account and network access. _______ Change sensitive access codes, including bank PINS and security codes. _______ Cancel phone and voicemail accounts. _______ Change locks. _______ Staff Notification Notify employees, clients and vendors about the termination and tell them who will handle the terminated employee’s responsibilities. _______ Answer an questions or concerns your staff may have about the termination without disclosing any sensitive information or infringing on the terminated employee’s privacy. _______ Human Resources, Payroll and Security Departments have been notified of employee’s departure. _______ Final expense report received, reviewed and approved. _______ Expense check prepared. _______ Final check prepared (includes all vacation pay, sick pay, accrued wages, bonuses, etc.) _______ Notice of unemployment rights provided. _______ Profit sharing election forms provided. _______ Company documents and files inventoried. _______ Desk and working premises inventoried. _______ Company has no further liability with the terminated employee. _______ _______________________ Date: __________________ (Printed Name of Supervisor) _______________________ (Signature of Supervisor) Department: _____________________