Staff Leaver Declaration Form

Staff Leaver Declaration Form
Staff Full Name*
Leaving Date*

DayMonthYear
Date
Staff personal email address*
This email will be used to send you the acknowledgement email for your reference
I confirm that all school property, data, and records will be returned prior to my leaving date. I understand that failure to do so may result in a breach of GDPR and a non-return of property may result in a deduction from my salary for the value of the items.

The list below is meant as a guide and is not an exhaustive list:
Select the items you have/had in your possession*

Laptop / Ipad / ICT equipmentMobile PhonePortable Data storage devices (e.g. memory stick etc)KeysID / Access PassDeletion of school documents / records from home/PC/Personal devicesTeaching / Subject Leader filesTeaching / Subject Leader resourcesAssessment Records / reportsPupil informationOther
Date returned - Laptop / Ipad / ICT equipment*

DayMonthYear
Date
Date returned - Mobile Phone*

DayMonthYear
Date
Date returned - Portable Data storage devices (e.g. memory stick etc)*

DayMonthYear
Date
Date returned - Keys*

DayMonthYear
Date
Date returned - ID / Access Pass*

DayMonthYear
Date
Date returned - Deletion of school documents / records from home/PC/Personal devices*

DayMonthYear
Date
Date returned - Teaching / Subject Leader files*

DayMonthYear
Date
Date returned - Teaching / Subject Leader resources*

DayMonthYear
Date
Date returned - Assessment Records / reports*

DayMonthYear
Date
Date returned - Pupil information*

DayMonthYear
Date
If you have selected Other, please state the item(s) name and date of return*
I understand that, as per our retention policy, my staff data is kept for 6 years from my leaving date and it will be treated as confidential information.
Staff Signature*

Clear
Date*

DayMonthYear
Date

OFFICE USE
Premises Manager / SBM / Headteacher Signature

Clear
Date

DayMonthYear
Date
Print Name

OFFICE USE
Should be Empty: