University of Massachusetts Boston: Budget Office

Office of Administration
and Finance
p: 617-287-5100
af@umb.edu

Human Resources Forms

Employee Exit Check Out Form

Instructions: Refer to policy FY 08-HRS-001-00. Department Heads are responsible for checking out their employees. This check out form is applicable to all employees except non-tenured system faculty. Please fill in blanks. Indicate actions as needed. Human Resources will email the Employee Exit Survey to the Employee.

• Exiting Employee Policy
• Exiting Employee Form Instructions

* Required fields

Submitted by:
First Name:		Last Name:*
Email:

Exiting Employee's Information:
First Name:
Last Name:*
Employee Email:*
Exiting Employee ID:		Exiting Employee's Dept Head:*
Last Working Date:		Exiting Employee's Dept Head Telephone Number:*
Termination Date from Payroll:		Exiting Employee's Dept:*
Required DATE for Follow- up:		Work Location: *

TYPE OF EXIT:
	EMERGENCY Exit Notification: Perform exit tasks immediately.
	Standard Exit Notification; there are no emergency security issues involved. (example: resignation)
	Retirement Faculty Staff
	Transfer of Position within UMass Boston
	Transfer of Position within University
	Leave of Absence
	Expected Date of Return:

Department Heads Final Check list
	PA has been Issued to HR
	Date:
	All applicable tasks complete (If equipment not returned, Burars' Office has been notified to bill exiting employee)

	Comments:

	COMPUTER APPLICATIONS AND SECURITY
	In accordance with the University's Data and Computing Standards, ALL University system accounts and access will be DELETED for terminated employees. Effective exit date defined by Dept Head

	EXCEPTION
	Dept Head may request to maintain the following as indicated.

	Application	Deletion Date
	Website Edit Rights
	R25 Access
	HEAT
	Email Account
	Account File Share
	People Soft Accounts
	FAIR
	VPN/Remote Access
	Web CT Access
	Remote access to library databases
	Interview exchange
	Wiser
	Other

DEPARTMENT HEAD CHECKLIST
Yes No N/A	Turn in letter of resignation to immediate supervisor
Yes No N/A	Turn in Employee ID Card.
Yes No N/A	Turn in Procard to Dept Head
Yes No N/A	Turn in Cell Phone to Dept Head
Yes No N/A	Turn in Keys- Campus Center employees return workstation keys and key access card.
Yes No N/A	Turn in all UMB equipment to Dept Head. All equipment not returned by employee will be billed directly to the employee by the Bursars' Office.
Yes No N/A	Return all library books and materials to library.
Yes No N/A	Contact Bursars' Office to clear any outstanding travel issues, alternative pay advance, and other outstanding bills.
Yes No N/A	Inform employee to Contact Parking and Transportation regarding Parking Pass
Yes No N/A	Inform employee to Contact HR for benefits information
Yes No N/A	Change Voice Mail Message and share with Department Head
Yes No N/A	Handle Confidential Materials (turn over to Dept Head, secure as directed by Dept Head)
Yes No N/A	Knowledge and skills transfer
Yes No N/A	Update, complete hand-off documentation & on-going projects and tasks
Yes No N/A	Clean up work area
Yes No N/A	Leave contact information
Yes No N/A	Complete Personal Data Change Form
Yes No N/A	Cancel Direct Deposit