Departing Employees

PREVENTION SCIENCES GROUP

CHECK OUT FORM FOR DEPARTING EMPLOYEES

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Departing Employee Information:

First Name:
Last Name:
Departure Date:
Supervisor/Contact:
Project/Core Name(s):
With which of the following groups is this person associated? (an email will be sent to key contacts in the selected group with employee info.)

Location:

Where is/was this person sitting?

Cube/Office#

What shall be done with the cube/office this person occupies/occupied?

We would like to retain it for future use.

It is no longer needed and can be reassigned to a different project.

This person did not have an assigned space.

Comments (if any) about location?

Computer and Email needs:

Will this person continue to use a computer or computer-related resources (email, printers, web, etc.) on our network?

Yes, they will continue to use the following computer and/or computer-related resources:

PC desktop

PC laptop

Macintosh desktop

Macintosh laptop

PSG network access

Other

No. (We will send you a System Access Request Form which you will need to fill out and return to the Help Desk.)

What should be done with this person’s existing computer once they leave?

It will be retained by the project for future use and should be left in its current location.

It will be retained by the project for future use and should be moved to (e.g., storage, Office/cube #).

This person did not use a computer while employed at PSG.

Is there anything else you would like to mention with regard to this person's email, computer, or network access resources?

Phones:

What should be done with this person’s phone line and voicemail?

Please keep both the line and voicemail active. (Note: You need to get the phone password from the departing employee to avoid a $40.00 password reset charge.)
Disconnect both the line and voicemail effective
They do not have a phone line or voicemail.

Other. Please explain

What should be done with this person’s entry on the phone list?

Remove it.
Keep on the list as is.
Keep on the list with the following modifications:

location , phone number

Is there anything else you would like to mention regarding this person’s phone/voicemail or related resources?

Other Facilities Items:

What should be done with this person’s door code?	It can be deleted It can be deleted from all but the following suite doors Please keep it active because
Does this person have a key fob?	Yes. It will be returned to 6th Floor Reception Yes. They need to retain it because No.
Does this person have office keys?	Yes. They will be returned to the 6th Floor Reception. Yes. They need to retain the following keys because No.
What should be done with this person’s mailbox?	It can be removed. It should be retained because They do not have a mailbox .
To whom and/or which address/box # should this person’s mail be directed?
Can this person’s cube/office tag be removed?	Yes No They do not have a cube/office tag.
Is there anything else you would like to mention with regard to this person's needs?

Requestor:

Requested By:
Phone:
Email: (an email confirmation is sent to this address)