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Employee Transfer / Separation Checklist

Employee ID No. Name ( Last, First , Middle Initial ) Department

This is to confirm your last working date with this department will be ___________________________. Please
coordinate with the different departments/units to complete the necessary checkout procedures. Please bring with
you the following, which our records indicate has been issued to you.

Date Issued Date Returned Description

ID Card
ATM Card
Keys (Office , Building, Others )
Management Guidelines/Manual
Policy Manual
Tools/ Equipment(See Attached list for specific items)
Others (attach list of other items)

Completed Authorizations and Other Exit Items (To assist the person conducting the check out)

Any Outstanding Liquidations / Reports

Reports Pending
Time Sheet Signed/Submitted
Files, Reports, and other company /client documents / properties returned
Computer Account/s Acces Deleted
Forwarding Address (for separations only)
Waiver and quitclaim Signed
Remove Name from Dept. Web Page / Directories
Security System Access / BundyPro System Access Deleted
Set up Exit Interview with HRAD (Optional at Employee`s or Superior`s Request)

Employee`s Signature Date Supervisor`s Signature Date

This form should be completed for all transferring or separating employees. The completed checklist should be
forwarded to HRAD, along with the employee`s transfer/ terminating Performance Appraisal Sheet.