HIPAA Compliance Termination Checklist
Complete this checklist to ensure all necessary HIPAA-related access and workflows are properly terminated. Do not enter any sensitive personal or health information.
Name of Individual or Entity Being Terminated
*
Department or Role
Termination Effective Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Checklist: Termination Tasks Completed
*
All user accounts and logins disabled
Remote access revoked (VPN, portals, etc.)
Physical access badges and keys collected
Company devices (laptop, mobile, storage) returned
Email and messaging access removed
Third-party system access revoked
Data backup and transfer reviewed
Security incident review completed
Other (please specify below)
If 'Other' selected above, please specify
Comments or Notes
Reviewed and confirmed by
*
Date of Review
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Checklist
Should be Empty: