Employee Offboarding Benefits Checklist Form
Use this checklist to document and confirm completion of all benefit actions and equipment/benefit transitions during employee offboarding.
Employee Full Name
*
First Name
Last Name
Employee ID or Reference
Last Working Day
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Checklist of Offboarding Benefit Actions
*
Health insurance cancellation/transition initiated
Retirement plan (401k, pension) transition/rollover provided
Company equipment (laptop, phone, access cards) returned
Access to benefits portals revoked
Final pay and accrued PTO processed
Other (please specify in notes)
Responsible HR/People Operations Staff
*
Date Offboarding Tasks Completed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Notes or Additional Comments
Submit Checklist
Should be Empty: