Clearance Checklist: For All Employees
Before completing this clearance, submit a Personnel Event Form or DHRS on-line document to appropriate Human Resources or Faculty Affairs Office, attaching resignation letter, layoff notification letter, termination letter, leave of absence request or any other documentation concerning the separation. This form should be initiated as soon as the separation is announced and must be submitted to the appropriate office as soon as all sections are completed.
A final paycheck will not be issued until this form is completed and submitted to check distribution.
Last Name: First Name: UM ID #: Rank or Title: Employee’s Check Distribution Code: Department: Campus: Date of Separation: Faculty Research Administrative Professional Clerical, Technical & Service
To be completed by Department Head (or designated Administrative Official):
Classification Clearance Needed Action Required Authorized By (Assistant Date and Campus From Director/Alternate) Submit the online Clearance Form (Provide termination/layoff date) found at http://www.miami.edu/index.php/benefits_administration/separation_from_ Employee Benefits the_university/benefits_clearance_request .
Additionally, tell the employee to contact the Benefits Administration Office for important information at 305-284-3004. Medical, To cancel direct deposit email [email protected]. Rosenstiel, & Payroll N/A Gables To ensure all IDs managed by IT security are deactivated, email IT Security [email protected] or fax the Clearance Checklist to 305-284-9335.
To disconnect telephone lines, sets, long distance security codes, network access services, DSL Service and AT&T Line/Services, a TSR (Telecommunications Service Request) must be submitted to the Telecommunications department. The form can be emailed Telecommunications ([email protected] ), faxed (305-284-5809) or sent by interoffice
mail to Telecommunications Dept, Gables One locator code 2921 (please do not send the Clearance Checklist to Telecomm IT Support Center/Telecomm). If you have any questions, please contact the IT Support Help Desk at 305-284- 6565.
Libraries (A) Richter Library : Submit online Clearance Form at As appropriate http://library.miami.edu/library-clearance-form/ (B) Calder Memorial Library: Call 305-243-6403
Revised 1/31/2013 Classification Clearance Needed Action Required Authorized By (Assistant Date and Campus From Director/Alternate) (C) Marine Library: Call 305-421-4060 Submit email to [email protected] indicating name, C# and termination/layoff date (last day worked). Do not provide Social Security Credit Union Number. Provide information as a courtesy only, check will not be withheld if N/A not completed.
Student Account Email [email protected]. N/A Services For Petty Cash or Travel Advance, call 305-284-3570. Disbursement Office For AMEX Purchasing, AMEX Corporate Card or US Bank Travel Card call 305- Corporate Cards 284-2417 or email [email protected].
Contact for clearance only if this employee has access to UM eNet Ariba Purchasing system. Call 305-284-5115.
Office Keys, Lab Space, Computer Access Codes, Equipment, Uniforms, Petty Cash, Reconciliation, Travel Advance/Expense Reports Outstanding, other Department Head department closeout procedures, etc.
Review web pages upon termination of employees for any web presence and Department Head update accordingly.
Recover ID Cards (i.e. Cane Card) from employee and forward to the Cane Card Office located on the first floor of the Flipse Building at 5665 Ponce De Leon Department Head Boulevard.
Please submit service request via www.miami.edu/sro to initiate this process. Facilities Management N/A Gables & To ensure all electronic access is deactivated (Onity and CBORD) and metal Rosenstiel keys are collected. *Note: it is the responsibility of the department to collect all Only Access Control issued keys and Cane Card
N/A Gables: Submit e-mail to [email protected] indicating name, C# and termination/layoff date. Parking Medical: Parking/Security (After 1 P.M.) For building access cards and keys call 305-243-6280.
Medical Human Submit copy of termination/resignation letter to fax 305-243-6503.
Revised 1/31/2013 Classification Clearance Needed Action Required Authorized By (Assistant Date and Campus From Director/Alternate) Resources Records Medical Information Send email to [email protected]. N/A Technology To cancel access to the Pyxis MedStation system for any employee who Medical had access: Hospital Only Please email the clearance list or name of employee who is no longer employed with the University to the appropriate site of employment.
Pharmacy Services Bascom Palmer/ABLEH: [email protected] N/A UMHC/SCCC Deerfield: [email protected] UMHC/SCCC Kendall: [email protected] UMHC/SCCC Miami: [email protected] UMHC/SCCC Plantation: [email protected]
To discontinue access call 305-243-5999, Option 3. UChart Call 305-284-4656. Property Control (A) Gables/South – Pre-Award Administration, call 305-284-4541. (B) Medical – Clinical Research Initiation Services (CRIS), call 305-243-7704. Research/Sponsored (C) Medical – Pre-Award Administration, call 305-243-6232. Programs (D) Marine – Pre/Post Award Administration, call 305-361-4080. As appropriate (E) Gables/South – Post-Award Administration, call 305-284-2665. Medical, (F) Medical – Post Award Administration, call 305-243-3825. Rosenstiel, & Gables Complete the Exit Interview Notification Form online. This form is to Human Resources notify the Human Resources Office of a departing employee. It must be Coral Gables completed prior to the separation date. Call 305-243-3400. *Requires a satisfactory closing inspection of the separating faculty Environmental member/researcher’s laboratories. The faculty member must consult Safety
Rosenstiel & Health/ Safety and Radiation Control Offices at least one month before separation concerning Gables Only the scheduling of inspections.
Radiation Control Call 305-243-6360. Center *Requires a satisfactory closing inspection of the separating faculty member/researcher’s laboratories. The faculty member must consult Safety and Radiation Control Offices at least one month before separation concerning Medical Only the scheduling of inspections.
Revised 1/31/2013 Classification Clearance Needed Action Required Authorized By (Assistant Date and Campus From Director/Alternate)
JMH/PHT Health Call 305-585-7305. Please note, for faculty this requires Medical Chart Information completion by full time attending physicians. Management UMHC/SCCC Health Call 305-243-5271. Please note, for faculty this requires Medical Chart Information completion by full time attending physicians. Management BPEI/ABLEH Health Call 305-326-6189. Please note, for faculty this requires Medical Chart Information completion by full time attending physicians. Management Animal Care and Use Call 305-243-2311. Committee Call 305-243-2100. Department of Requires a complete room inventory of space assigned to faculty member Administrative upon separation. Services All UMMG faculty must complete the most recent quarter of the physician Home Department online time and effort report.
Call 305-243-3195. Please note: Faculty must submit a final report or transfer Human Subjects PI ship of ongoing clinical research trials prior to clearance. All personnel must be removed from ongoing studies prior to granting clearance.
To be completed by the Departmental Administrative Official submitting this clearance form: Please note: by signing this form, the department certifies this checklist is complete and authorizes release of the employee’s final payroll check (per policy). Print Name: Title: Signature: Telephone : Department: Date:
Forward this completed form via Interoffice Mail to the Check Distribution Office, 129 Ashe Building, Locator Code 4613 or by fax to 305-284- 6707.
Check Distribution Acknowledgement: Signature: Date: Final paychecks will be mailed to the address of record.
Revised 1/31/2013