Employee:

Department:

Termination Date:

Complete or return upon termination each of the items marked with an ("x.").

To return:

ID Badge

[ ] Credit Cards

[ ] Petty Cash Advances

[ ] Expense Accounts

[ ] Keys to Premises

[ ] Company Tools

[ ] Desk/File Keys

[ ] Security Statement

[ ] Air Travel Cards

[ ] Catalog/Sales Items

[ ] Sample Products

[ ] Vehicles

[ ] Company Documents

[ ] Customer Lists

[ ] Other:

To complete:

[ ] Exit Interview

[ ] Expense Reports

[ ] Terminations Form

[ ] Confidentiality Report

[ ] Other:

______________________ Date:

Supervisor

Mark an 'x' in the second column as each item is returned or completed.