This document is a termination checklist for an employee leaving a company. It lists items for the employee to initial confirming they were received, such as their final paycheck and change in relationship form. The employee also signs confirming they have returned all company property, and provides their forwarding address and signature. The checklist also includes items for the employer, such as notifying payroll, benefits, and IT to process the final tasks related to the employee's termination.

1. Company Logo Here
Termination Checklist
For Employee:
Please initial all that apply:
□Received Final Paycheck □Outstanding Expense Reports Submitted
□Received Change in Relationship Form □Received HIPP Notice
□Received “For Your Benefits”–DE 2320 □Exit Interview Survey Completed
□Returned Keys and Badge □Returned Company Credit Cards
□Returned Company Property: documents, files, software, artwork, client prototypes,
Other items belonging to the Company.
□Provided Passwords: Phone: Computer:
□Personal Email Address:
□Forwarding Address:
Street City & Zip Phone Number
Your signature below indicates that you have returned all of the Company’s property or
property belonging to its clients. If you discover that you have additional property
belonging to the Company or its clients, you will return it immediately.
Employee Signature Date
Print Name
For Employer:
□ Payroll Authorization Form Completed □ Final Paycheck Requested
□ Employee Removed for Health Benefits □ IT Notified to Cancel Passwords/Email
□ Notify Security □ Review and close out Personnel File
□ Check for Outstanding Commissions □ MKT Notified to remove bio from website
□ Health Benefits’ Carriers Notified (and COBRA)
Exit Completed by (Print) Date