Employee Clearance Checklist Form
Complete this Employee Clearance Checklist Form to ensure all offboarding steps are accurately documented and processed.
Employee Full Name
*
First Name
Last Name
Department
*
Please Select
Engineering
Sales
Marketing
Finance
HR
Operations
Other
Last Working Day
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Responsible Manager Name
*
First Name
Last Name
Company Assets Returned (select all that apply)
*
Laptop
Mobile Phone
Access Card/Badge
Other Equipment
System Access and Credentials Deactivated (select all that apply)
*
Email
VPN
HR/Payroll System
Other Systems
Facilities Clearance Completed
*
Yes
No
IT Department Clearance Completed
*
Yes
No
Finance/Payroll Confirmation Completed
*
Yes
No
Final Remarks
Submit Clearance
Should be Empty: