Offboarding Checkout Form

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					                                          UNIVERSITY OF MICHIGAN HEALTH SYSTEM - OFFBOARDING CHECKLIST
GENERAL INSTRUCTIONS
   This form is used to document the return of Health System property and allow for the proper processing of employee transfers and separations.
   The form is to be completed by the Direct Supervisor or designee for every transferring or separating employee. The form is a tool for the
   Supervisor/Department, so upon completion of the form, the form can be filed with the Supervisor or maintained in department records. It is not
   required to be maintained in the employee's Blue Folder.


SECTION I: Identification

   Employee Name:                                                                                                    Employee ID:
   Supervisor's Name:                                                                                 Last Day Worked (xx/xx/xx):
   Separation
   Transfer                           Dept Transferring To:

SECTION II: Return of Property
  For any items that are not applicable to the employee, please indicate "N/A" in the 'Date Returned' column.


                                                                            Action                                                     Supervisor's   Date Returned
                              Property                                                                     What to Do
                                                                      (Separation/Transfer)                                              Initials        (xx/xx/xx)




   MCIT Systems                                          i.e.                                 At time of termination - Pathology HR
                                                                        Separation or
   Novell/Groupwise, CareWeb, , Mlearning, UMCL or other                                      submits form to Pathology Informatics
                                                                          Transfer
   Health System specific accts                                                               to delete this access.



                                                                                              To terminate/delete access any staff
                                                                                              member can complete the Online
                                                                                              Access Request form at
                                                                                              https://weblogin.umich.edu/?cosign-
                                                                                              accessrequest.dsc&https://accessreque
   ITS Systems                                              i.e.                              st.dsc.umich.edu/servlet/MaisDominoL
                                                                        Separation or
   MPathways/Wolverine Access/eMploy/WebNow/Data                                              ogin. The form is authorized and
                                                                          Transfer
   Warehouse                                                                                  submitted to Access Services by the
                                                                                              Unit Liaison for processing. To have
                                                                                              the request expedited the Unit Liaison
                                                                                              should contact Access Services 764-
                                                                                              HELP (764-4357) once it has been
                                                                                              submitted.

   Other System Access: i.e. Health
                                                                        Separation or          Remove access via process for that
   System Data Mart, Departmental
                                                                          Transfer                         system
   databases
                                         UNIVERSITY OF MICHIGAN HEALTH SYSTEM - OFFBOARDING CHECKLIST
                                                                 Separation or   Collect; retain for reassignment or
Building/Office Keys
                                                                   Transfer             return to Key ID office
                                                                                 Collect; retain for reassignment or
                                                                 Separation or
Key Card for off site buildings (Arbor Lakes, Domino Farms, etc)                return to your department's contact
                                                                   Transfer
                                                                                     person or building security

ID Badge                                                                                   Collect and return to Key ID office
                                                                         Separation
                                                                                          Collect and destroy. Fill out Pcard
                                                                        Separation or
Purchasing Card (P-Card)                                                                Maintenance form and fax to: 734-764-
                                                                          Transfer
                                                                                                        3574
                                                                        Separation or
Pager                                                                                     Return to Paging (Domino's Farms)
                                                                          Transfer
                                                                        Separation or
PDA/Blackberry                              (if issued by Department)                       Return to Pathology Informatics
                                                                          Transfer
                                                                        Separation or
Cell Phone                                  (if issued by Department)                       Return to Pathology Informatics
                                                                          Transfer
                                                                        Separation or
Headset and Accessories                     (if issued by Department)                       Return to Pathology Informatics
                                                                          Transfer

                                                                        Separation or
Laptop/tablet and Accessories               (if issued by Department)                       Return to Pathology Informatics
                                                                          Transfer
                                                                        Separation or
Hard Drive or Jump Drives                   (if issued by Department)                       Return to Pathology Informatics
                                                                          Transfer
                                                                                          Collect and return to ITS Access
                                                                        Separation or
M-Token (Wolverine Access)                  (if issued by Department)                     Services (2019 ASB Box 1432 via
                                                                          Transfer
                                                                                                    campus mail)
                                                                        Separation or
Uniform                                     (if issued by Department)                        Based on departmental policy
                                                                          Transfer

                                                                                             Transfer work related emails to
                                                                                         another employee and save work files
                                                                                          to shared drive. MCIT recommends
                                                                        Separation or
Employee's Computer Files and Personal Network Storage,                                 that you submit a MCIT service request
                                                                          Transfer
                                                                                               for electronic device to be
                                                                                         reimaged/wiped to remove any legacy
                                                                                                    data for next user.
                                                                        Separation or     Collect and retain as departmental
Books, Binders, or Notes that may be required for future work
                                                                          Transfer                     resource
                                                                                         Instruct employee to save electronic
                                                                        Separation or
Patient information (records, appts, etc.) completed or reassigned                       records to shared space and collect
                                                                          Transfer
                                                                                                    paper records
                                                                        Separation or     Collect and retain as departmental
Security Equipment                            (Security Dept only)
                                                                          Transfer                     resource
                                           UNIVERSITY OF MICHIGAN HEALTH SYSTEM - OFFBOARDING CHECKLIST
                                                                        Separation or Collect and retain as departmental
   Tools or Equipment                     (Maintenance/Facilities only)
                                                                          Transfer                 resource
                                                                         Separation or      If transfer, send to new department; if
   Blue Folder                             (UMHHC Staff only)
                                                                           Transfer         separation, keep in dept file for 7 years

   Other:

   *See UMHHC Policy 01-04-511: Assignment and Retrieval of IT Access and Property

SECTION III: Supervisor (or Designee) Discussion Checklist
   Process Items - Transfers
        Employee or you has updated voicemail and email (if appropriate) with an 'out of office' reply, indicating a contact person.
        Employee has been reminded to confirm their parking pass will work for their new location.

   Process Items - Separations
       The employee's termination paperwork was completed and sent to HR.
        If required, a Termination Letter has been completed. (i.e., Employees terminated during Probation and marked "Not Eligible for Rehire"
        are required to receive Termination Letters)
        The employee has been informed of their rehire status, expected date of their last check, and whether their accrued PTO/Vacation will be
        included. (Get check information from your timekeeper)
        The employee has been reminded to contact the Benefits office regarding questions on COBRA coverage, their 403(b) account, etc.
        (HR/Payroll Service Center at 734-615-2000)
        The employee has been reminded to update their address in Wolverine Access if their home address is changing (for year-end W2
        purposes).
        The employee has emptied their office/desk/locker of their personal belongings.
        Employee has updated voicemail and email with an 'out of office' reply, indicating a contact person.
        The employee has been reminded to contact the Campus Parking Office for information on turning the parking pass in. (Employee is
        responsible for the cost of the parking pass until it is returned to the Parking Office - 777 North University - at 734-764-8291.)

   Updated 2/28/10

				
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