"Employee Termination Checklist" - Utah

Employee Termination Checklist is a legal document that was released by the Utah Department of Human Resource Management - a government authority operating within Utah.

Form Details:

  • Released on August 31, 2018;
  • The latest edition currently provided by the Utah Department of Human Resource Management;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Utah Department of Human Resource Management.

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Employee Termination Checklist
Last updated 8/31/2018
This checklist was designed to assist supervisors when an employee terminates as a guide for
possible steps, items to be collected and reminders of important steps to follow.
Employee Section
Name:
EIN #:
Agency Employed By:
Reason for Leaving:
Date of Notice:
Last Day Worked:
AUDIX Password:
Computer ID:
Updated Contact Information
Phone:
Address:
City:
State:
Zip Code:
As I separate from my employment, I certify that I have returned or am now returning all items in my possession that
are the property of the State. I understand the possibility of my last paycheck being held if any money or property
owed the State of Utah is still outstanding.
Employee Signature:
Date:
Supervisor Section
□ Please check here if employee declined an exit interview.
□ Attach all disciplinary documentation (if applicable).
□ Confirm and record last day of work here:
□ Request return of and collect all State property.
□ ID / Security Card
□ Other:
□ Keys
□ Other:
□ Money Owed to State (tuition, phone bills,
□ Other:
credit card, etc.)
□ Other:
□ State Owned Equipment
□ Other:
□ Fill out final timesheet or help employee complete final ESS entry.
□ Notifiy local HR the employee is terminating
Supervisor Signature:
Date:
Employee Termination Checklist
Last updated 8/31/2018
This checklist was designed to assist supervisors when an employee terminates as a guide for
possible steps, items to be collected and reminders of important steps to follow.
Employee Section
Name:
EIN #:
Agency Employed By:
Reason for Leaving:
Date of Notice:
Last Day Worked:
AUDIX Password:
Computer ID:
Updated Contact Information
Phone:
Address:
City:
State:
Zip Code:
As I separate from my employment, I certify that I have returned or am now returning all items in my possession that
are the property of the State. I understand the possibility of my last paycheck being held if any money or property
owed the State of Utah is still outstanding.
Employee Signature:
Date:
Supervisor Section
□ Please check here if employee declined an exit interview.
□ Attach all disciplinary documentation (if applicable).
□ Confirm and record last day of work here:
□ Request return of and collect all State property.
□ ID / Security Card
□ Other:
□ Keys
□ Other:
□ Money Owed to State (tuition, phone bills,
□ Other:
credit card, etc.)
□ Other:
□ State Owned Equipment
□ Other:
□ Fill out final timesheet or help employee complete final ESS entry.
□ Notifiy local HR the employee is terminating
Supervisor Signature:
Date: