Employee Termination Benefits Recognition Log
Document and acknowledge the recognition of benefits provided to employees upon termination.
Employee Full Name
*
First Name
Last Name
Employee ID (if applicable)
Department
*
Please Select
Human Resources
Finance
Operations
Sales
Marketing
IT
Other
Position/Job Title
*
Employee Email Address
*
example@example.com
Employee Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Last Working Day (Termination Date)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Termination
*
Please Select
Voluntary Resignation
Retirement
Layoff/Redundancy
Performance Related
Misconduct
End of Contract
Other
Termination Benefits Provided
*
Rows
Benefit Type
Amount/Value
Status
Benefit 1
Severance Pay
Unused Leave Payout
Final Salary
Bonuses
Health Insurance Extension
Other
Paid
Pending
Not Applicable
Benefit 2
Severance Pay
Unused Leave Payout
Final Salary
Bonuses
Health Insurance Extension
Other
Paid
Pending
Not Applicable
Benefit 3
Severance Pay
Unused Leave Payout
Final Salary
Bonuses
Health Insurance Extension
Other
Paid
Pending
Not Applicable
Additional Notes or Comments (optional)
Employee Signature
*
Name and Title of HR/Management Representative
*
HR/Management Representative Signature
*
Submit Log
Submit Log
Should be Empty: