SEPARATION FORM
Termination Task Checklist
Employee:
Employee Number:
Department:
Position:
Last Date Worked:
Separation Effective Date:
Shift:
1st
2nd
3rd
Employment Type:
Full Time
Part Time
Seasonal
Temporary - Manpower
Reason for Separation
Voluntary:
Another Job/School
No Call No Show/Job Abandonment
Medical
Retired
Disliked Job
Moving
Personal
Other
Involuntary:
Attendance
Layoff
Performance
Company Violation Misconduct
Other
Comments:
Approvals
Full Name: Manager/Supervisor:
Your typed signature serves as your legal signature.
Date:
-
Month
-
Day
Year
Approved?
Yes
No
Supervisor Code (if already filled out, please clear before submitting the form):
If this field is filled out, please clear before submitting.
Do Not Click
Submit to Human Resources
Full Name: HR Manager:
Your typed signature serves as your legal signature.
Approved?
Yes
No
Date:
-
Month
-
Day
Year
Eligible for Cobra?
Yes
No
Eligible for Re-hire?
Yes
No
Submit to HR Staff
Termination Task Checklist
HR Form Processor Name:
Termination Task Checklist
Complete
Not Applicable
Forward Email & VM if applicable
Email HR, Payroll, AR/AP, COO, Production Manager & Supervisor of Termination
Email IT of termination (network access, phone, email)
Courtesy email to office personnel regarding term (Typically salaried)
Conduct Exit Interview
Transition agreement (if applicable)
Inactivate employee # for doors
Cobra letter (if eligible)
Terminate employee in Optimum
Terminate employee in Navigator (if applicable)
Terminate employee in TCM
Terminate employee in Filemaker (Training Matrix)
Terminate employee in Fastenal Vending
Additional Considerations
Complete
Not Applicable
Onboarding Binder
Keys
Credit Card(s)
Laptop
Submit to Complete
Payroll/Finance
Date of last payroll check:
Zero/pay out PTO hours in Optimum:
Notify DHS; State (if applicable) - garnishments, child support, etc.
Should be Empty: