PDF Employee Separation Checklist

[Pages:4]NCDOT EMPLOYEE SEPARATION CHECKLIST

The purpose of this checklist is to ensure that employees separating from NCDOT employment: 1. are informed of their rights for extension of health care coverage under COBRA and other benefit coverage issues, 2. return all property belonging to NCDOT for audit purposes, and 3. are separated in a timely manner.

Completion of this checklist is the responsibility of the employee and employee's immediate supervisor with the assistance from the HR Personnel Technician/Administrator. All parties must sign and date the checklist. In the event, where the employee's signature is not attainable i.e. death, hospitalization, etc. please provide a brief statement explaining the issue on the employee's signature line. The HR Personnel Technician/Administrator must scan this document into BEACON along with the resignation letter when completing the separation action. If for some reason this checklist is not completed at the time of separating the employee, please email Dennis Franz.

If completing this form electronically, the fields will adjust to the amount of information entered. If completing this form by hand, please attach additional pages as needed.

Name

Last Date of Employment

Job Title

Forwarding Address

Supervisor

Email/Telephone

TYPE OF SEPARATION VOLUNTARY INVOLUNTARY

Obtain written letter of resignation/retirement from employee. Forward original to HR Personnel Technician/Administrator.

Consult with Human Resources prior to termination.

NOTIFICATIONS: For ALL separations including full-time, part-time and temporary employees, contractors, and

others employed by third parties who perform work on NCDOT premises or anyone granted access to Department

computing systems.

Yes

No

N/A Comments

This action will notify IT of what access needs to

be terminated. (NCID, email, data systems, etc.)

Notify appropriate HR Personnel Technician/Administrator to initiate IT separation process of NCID, email, data systems, etc.

If the employee does not have an NCID or work e-mail address, then N/A is appropriate.

If the answer is Yes, the HR Personnel Technician/Administrator will need the employee's NCID or work e-mail address.

Notify appropriate HR Personnel Technician/Administrator of last day worked so separation action can be initiated in BEACON.

Notify appropriate HR Personnel Technician/Administrator, when employee is transferring to another NC State Government Agency.

Name of HR Personnel Technician/Administrator notified :

________________________ Date: ___________

If the employee does not have an NCID or work e-mail address, then N/A is appropriate. If answer is yes, name of NC State Government Agency transferring to:

_______________________________________

Exit Form 2

1

Revised 2/1/2019

For full-time permanent and time limited employees

Provide to Full-time Permanent, Time Limited employees.

Email: dotneogov@

1. NCDOT Exit Survey (direct employee to Inside DOT Portal, Employee Page for On-Line Survey or provide paper form if requested)

2. NCDOT Separating Employee Information Sheet (includes COBRA and other benefit information)

3. NCDOT Knowledge Transfer Form (optional)

If the separating employee has a defined access role in NEOGOV, be sure to notify HR when the employee leaves so their account can be deactivated.

For full-time permanent, temporary and time limited

Yes No

employees

Close out NCVIP (does not apply to temporary employees)

1. For employees departing state government, or transferring

to another unit/agency, launch and complete a Performance

Evaluation for Transfers & Separations (PETS).

2. For supervisors departing state government, or transferring

to another unit/agency, launch and complete a PETS for

each of their direct reports.

Finalize all expense reports and reimbursements

Received any NCDOT work records held off-site i.e. home office, work vehicle, etc.

Withdraw employee from any ILT Sessions they are registered for in the NC Learning Center.

Separating employees who have direct reports should: 1. Log into the NC Learning Center, open the "My Team" screen, and act on any pending requests in the "Action Items" folder 2. Open the "My Account" screen, check the "Out of Office" box & click on "Save"

N/A Comments

Contact your Division/Unit Training Coordinator.

RETURN OF PROPERTY (All Employees including Full-time, Part-time & temporary employees, contractors, &

others employed by third parties who perform work on NCDOT premises.)

Return to

The following property has

Yes No N/A

Supervisor

Employee

Comments

been returned:

Initials

Initials

NCDOT Security Badge

Return to Security Section

NCDOT Business Cards

Credit Card(s) - P Card, American Express, Gas, etc.

Keys - Building, Office and/or State Vehicle - Desk/File Cabinet

Other Equipment Assigned: - Cell Phone, Charger and Adapter - Pager

2

Destroy

Exit Form 2 Revised 2/1/2019

- Tools and Work Equipment (e.g., uniforms, hard hat, camera) - List Others:

The following property has been returned: CONTINUED

Yes No N/A

Computer Equipment - Office Computer or Laptop - Licensed Software - Software on Home Computer - Flash Drive(s) or Disks - Printer - Other Peripherals Notify Parking (Raleigh Area Only) **Ensure (hang-tag/transponder) is returned to DOA, as applicable**

Travel and/or Petty Cash Advances

Return to

Supervisor

Employee

Initials

Initials

Comments

Contact NCDOT Parking Coordinator

(919) 707-4855 DMV Contact

(919) 861-3015

ncdotparking@

Provide Supervisor:

- Voice Mail Access Code

State Car/Truck: - Gas Card - Gas Key - Vehicle # - Make/Model

Comments

Employee - I agree all items indicated have been discussed with me and a copy of the NCDOT Separating Employee Information Sheet has been given to me. I certify that all items and monies issued to me during my employment have been returned as noted above. I also understand that as of my separation date with NCDOT, I will no longer access State or NCDOT computing systems using previously authorized credentials. I have been given the opportunity to complete an NCDOT Exit Survey.

Employee's Signature

Date Signed

Supervisor/Manager ? I have reviewed all of the information included on the NCDOT Employee Separation Checklist with the separating employee. I have collected all property as noted above. In the event, where the employee's signature is not attainable i.e. death, hospitalization, etc. I provided a brief statement explaining the issue on the employee's signature line. I have received a written resignation letter from the employee or I have completed a resignation document on the employee's behalf and sent this to my HR Personnel Technician/Administrator. I understand I also need to send this document to my HR Personnel Technician/Administrator.

Supervisor's/Manager's Signature

Date Signed

Exit Form 2

3

Revised 2/1/2019

HR Tech/Administrator ? Please scan this document into BEACON along with the resignation letter/resignation document on employees behalf when completing the separation action. If for some reason this checklist is not completed at the time of separating the employee, please email Dennis Franz. If you have any questions, please call (919) 707-4430 or send an email to djfranz1@.

HR Tech/Administrator's Signature

Date Signed

Appendix A

Note: One e-mail can be sent to all applicable parties (HR Tech/Administrator, HR,).

Subject: Employee Separation Employee's name is: First, Middle, Last Separation Date is: mm/dd/yyyy Employee's NCID is: Employee's work E-mail address is: Employee's NEOGOV account ID is: Employee's Beacon number is: Employee is transferring to: SAP Account Name (can be different than NCID or AD) Active Directory Account Name (can be different from NCID)

Exit Form 2

4

Revised 2/1/2019

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