Employee Name: _______________________
Date of Termination: ______________________
Collect the following items from the employee prior to separation from the company:
Content Continues Below
All keys returned Company vehicle keys returned Company vehicle returned Company credit cards returned Company phone credit cards returned Company equipment (e.g., cell phones, pagers, credit cards, laptop computers) returned COBRA election forms signed and returned 401(k) election forms signed and returned Profit-sharing election forms signed and returned Company documents and files inventoried Desk and working premises inventoried Personnel and Payroll Departments notified of departure Final expense report received, reviewed and approved; expense check prepared Final check prepared (including all accrued vacation pay, sick pay, accrued wages, bonus, etc.) Exit interview prepared Exit interview given Final checks (payroll and expense) given to terminating employee
All of the above duties have been completed in a satisfactory manner.
Company has no further liability with terminating employee.
Manager Signature _______________________________________ Date __________________