<p> Page 1 of 2</p><p>Revised: 03/2018 Wichita State University Employee Separation/Transfer Checklist</p><p>Employee’s Name: Location (Building & City): Department Name: myWSU ID#: Classification: Effective Date: Type of Termination (Resignation, Retirement, Disability, Layoff, Transfer, Disciplinary or Death):</p><p>Resignation, Activity Layoff, Transfer or Retirement Disability Death Disciplinary N/A To Do Done N/A To Do Done N/A To Do Done N/A To Do Done Department to Collect: 1. Letter of Resignation (original to HR) X X 2. Computer Equipment and/or Software 3. Cell/mobile device 4. Keys (building, equipment, desk, locker, etc.) 5. Corporate Credit Card (i.e. VISA) 6. State/Department ID cards or badges 7. Equipment (tools, uniforms, etc.) 8. Supplies (books, files, manuals, etc.) 9. Final Exception Report (copy to HR) Department to Schedule/Complete: 1. Change of Status paperwork 2. Office/locker cleanout 3. Removal from Phone List 4. Change desk phone voicemail 5. Cancel phone PIN# (Univ. Telecomm) 6. Disable computer access (Univ. Computing) 7. Update Organization Chart</p><p>Note completion date of all “to do” items to be collected, scheduled, and/or completed for an employee leaving the department. Sign and date below and turn into department leader. Employee’s Supervisor or Designee: Signature:______Date:______Page 2 of 2</p><p>Employee’s Name: myWSU ID#:</p><p>Resignation, Activity Layoff, Transfer or Retirement Disability Death Disciplinary N/A To Do Done N/A To Do Done N/A To Do Done N/A To Do Done Human Resources – Timekeeping (to set up a time to meet please email [email protected]): 1. Letter of Resignation X X 2. Exit Status Review Form X X 3. W-4 change discussed X X 4. Receipt of final paycheck discussed X X 5. Financial Obligation Form discussed X X 6. Verify Current Address X X 7. Vacation and/or Sick Leave discussed X X 8. Shared Leave Donation Form discussed X X 9. Collect any keys, credit cards, etc. not collected by department. X X 10. Data entered on BANNER Human Resources – Benefits (to set up a time to meet please email [email protected]): 1. Insurance ending dates discussed – life, group health (summer coverage or lump?) 2. Conversion of Life Insurance explained 3. COBRA provisions explained 4. Flexible Spending Account 5. KPERS/KP & F/Board of Regents retirement fund status discussed 6. Finalize group health coverage change form X X **If you would like to meet with both timekeeping and totalrewards, you only need to email one. Indicate in your email you desire to meet with both and we will set up an appointment where you can meet with both.</p><p>Human Resources – Timekeeping:</p><p>Signature:______Date:______</p><p>Human Resources – Benefits:</p><p>Signature:______Date:______</p>