An Employee Separation Checklist can help minimize confusion, misunderstanding, and
error and reiterate both the employer’s expectations and its legal requirements. A
separation checklist is a reminder of tasks that must be completed before the ties
between the employer and employee are permanently severed. It should provide
specific details about required actions and set a clear course of action for human
resources and other staff managing the departure. Though terminating an employee or
requesting the return of property from a departing employee can be uncomfortable, it is
a task that must be completed.
Employee Separation Checklist -- Short
Name of Employee:_______________________________________________;
Effective Date of Separation: ___________________________
In connection with the separation of your employment, you have the following obligations:
1. Return all Company materials, documents, data, whether in paper or electronic form and
all Company equipment and property (all of which are hereafter referred to as Company
Property,) including, but not limited to:
Keys to Company property.
Parking/building access card.
Computer, Model ________________________
Laptop, Model ________________________
Printer, Model ________________________
Company credit cards.
Other (specify) _______________________________________________
2. Repay any outstanding advances owed to the Company on or before separation date,
such as expense advances. Debts owed to the Company that are subject to repayment through
payroll deductions will be deducted from the final check to the extent permitted by law.
3. Comply with the Company’s trade secret and confidentiality agreement (or policy)
including your continuing obligation to maintain the confidentiality of Company proprietary
4. Your access to the Company’s computer system ends on (date).
5. Your health benefits will terminate on (date).
6. You were informed about your Cobra Health Insurance rights on (date).
7. All amounts owed to you by the Company were paid by Check No. ________ in the
amount of $_________ and was received by you on (date).
WITNESS our signatures this the _____ day of ______________, 20______.
(Name of Employer)
(Printed Name of Employee) (Printed Name & Office in Corporation)
(Signature of Employee) (Signature of Officer)
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