Exit Interview Checklist
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1EXIT INTERVIEW CHECKLIST
TO ASSIST SUPERVISORS WITH SEPARATING EMPLOYEES
Employee Name:
Term Date:
Supervisor/Dean:
Department:
The following items have been reviewed/completed with the
employee and their supervisor/dean:
Comments:
Complete a CPD/UPD, attach the original separation letter
provided by employee and submit to Human Resources (WA336).
If employee supervised other positions, ensure the appropriate changes
are made to the "supervisor of record" for the affected positions.
If completing a UPD, CPD or PRF this should be noted in the applicable fields.
For all other situations, please complete the "On Campus Information Change Form".
Have Employee complete, sign, and submit to Human Resources (WA336)
final time sheet (if applicable).
Collect any state property in the employee's possession; examples
include: keys, computers, laptops, PDAs, cellphones, library materials etc.
Collect employee's ID card and/or ID tag/badge.
Collect any purchasing card(s), corporate credit card(s), issued to the
employee.
Work with employee to ensure transfer of electronic data before the
employee departs. After the employee leaves, supervisors will NOT be
granted access and computers will be scrubbed.
Terminate employee's access to any and all computer systems.
Obtain forwarding address and/or E-mail.
Confirm employee has provided a new address to or canceled any
magazine subscriptions and other personal mail sent to their
Minnesota State Mankato address.
PLEASE complete, sign and date this document and send to Human Resources (WA 336).
Employee's Signature
Date
Supervisor/Dean
Date
Minnesota State Mankato is an Affirmative Action/Equal Opportunity University.
This document is available in alternative format to individuals with disabilities by calling Human Resources at (507)387-2015 (V) or (800)627-3529 (MRS/TTY).
Last Rev. 03/2010
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