Termination Checkout Form

Instructions:

Complete the form entirely.

Click the SUBMIT button.

NOTE: *Required Fields

Employee Name: *

Date Submitted: * +

Termination Date: * +

Title: *

Supervisor Name: *

If a student worker, will student return in same capacity next semester? (pending budget approval)

Yes

No

Forms/Misc. *

	Yes	No
Requests/Collect resignation letter	Yes	No
Complete and submit Technology Checkout Form	Yes	No
Return Uniform Receipt Form to Human Resources	Yes	No
Conduct Employee/Supervisor exit meeting	Yes	No
Schedule Employee/HR meeting	Yes	No
Conduct a Security Risk Assessment-is a possible workplace violence scenario likely to erupt from the termination? Is a possible sabotage or theft of college information likely to erupt from the termination?	Yes	No

Collect the following items during the Employee/Supervisor exit meeting *

	Received	N/A
Keys (office)	Received	N/A
Keys (building)	Received	N/A
Keys (classroom)	Received	N/A
Keys (shop/lab)	Received	N/A
Tools	Received	N/A
Uniforms	Received	N/A
Equipment (laptops, cell phones, etc.)	Received	N/A

Would you rehire this employee? *

Yes

No

If no, why? (check all that apply) ***Note: You may be required to provide additional documentation to support your reason.

	Check all that apply
Lack of proper notice	Check all that apply
Performance	Check all that apply
Attendance	Check all that apply
Policy violation	Check all that apply
Not an organizational culture fit	Check all that apply
Other	Check all that apply

If other, please describe:

Questions about this form? Contact Heather Myers.