Employee Clearance Form

Name:
Designation: Employee ID:
Department: Contact No.:
DOJ: Last Duty Date:
NAME & SIGNATURE OF
DEPARTMENT REQUIRED DOCUMENT AUTHORIZED SIGNATORY
□ Keys
□ Equipment
□ Office Stationary
HEAD OF DEPARTMENT
□ Office Files & Documents
□ Passwords
□ Others _________________
□ Keys
□ Water & Electricity Bills
STAFF ACCOMMODATION
□ Telephone & Internet Bills
□ Rent
IT DEPARTMENT □ IT related Equipment / Documents
(Mobile, Laptop, Access Card, etc.)
□ Password
PHARMACY □ Outstanding bills
BIO-MEDICAL DEPARTMENT □ Medical Equipment
RADIOLOGY □ Dosimeter
□ Files / Documents
MEDICAL RECORDS DEPARTMENT □ Others _________________
ACCOUNTS DEPARTMENT □ Loans
□ Advances
HOUSEKEEPING □ Uniforms ___ Pairs
TRAINING & CERTIFICATIONS □ BLS □ PALS □ ACLS
□ External Training
□ Name Badge & Tag
□ Stamps & Business Card
□ Insurance Card
□ Family Insurance Cards
H.R DEPARTMENT
□ HAAD License
□ Passport & Labor card/Emirates ID
□ Family Visa Cancellations
□ Bank Liability Letter
□ Salary Transfer Letter
□ Leave Balance : ___________________________ □ Ticket : ___________________________
□ Experience Certificate □ Exit Interview

HR Manager : ___________________ General Manager/CEO : ________________________

FRM HR.004.1.0 | EMPLOYEE CLEARANCE FORM | Page: 1 of 1

Propriety information: This document and contents hereof are considered propriety and confidential information of YAS Clinic Group, and disclosure to
unauthorized individuals or dissemination, publication or copying is prohibited without prior written consent.