Separation Exit Checklist
Name of Employee
Date of Termination
Employee's Title
Important:
All sections of this form must be signed by the authorized representatives before your termination can be
finalized. Your final paycheck, termination pay, and/or retirement refund may be delayed until the
completion of this process.
This form must be returned to the Office of Human Resources before 5:00 p.m. of your last working day.
Employing Department/Division
Yes
No
N/A
Has a letter of resignation been submitted to the President of the College, or a signed resignation
form been submitted to the immediate supervisor?
Has the Office of Human Resources been notified of this termination?
Have all College equipment, books, and property been returned?
Have all records, class reports, and advisor files been turned over to the appropriate division director?
Have College uniforms been returned?
Have the employee's desk, files, lockers, etc. been cleaned out?
Authorized Signature
Library & Audiovisual Services
Yes
No
N/A
Have all books (if applicable), been returned to the Library?
Authorized Signature
Has all WPCC issued equipment been returned to IT?
Authorized Signature
Buildings & Grounds Office
Yes
No
N/A
One week prior to leaving, check with the Business Office for a key inventory list issued to you.
Have all College keys (office, building, desk, etc.) been returned?
Authorized Signature
Human Resources Office
Yes
No
N/A
Exit interview questionnaire complete?
Retirement refund or retirement processing completed?
Insurance continuation completed?
Change of address form completed?
Notification sent to Technology Division Help Desk to terminate WPCC computer accounts?
If non-exempt employee, is there a comp leave balance, if so, what is the amount?____________
Notify Security of employee's termination of employment.
Authorized Signature
Separation Exit Checklist: 03.04.030 | 06/06/2016