EMPLOYEE SEPARATION CHECKLIST
Contractor: _________________________________________________ Contract No: __________________________
Departing Staff Member’s Name: ________________________________ Separation Date: _______________________
Check and complete one of the columns below as appropriate:
I. FRIENDLY SEPARATION II. UNFRIENDLY SEPARATION
Date
(Mandatory)
Action
Date
(Mandatory)
Action
Remove all network and system access
privileges.
Disable system access as quickly as
possible–preferably just before the individual is
notified of his or her dismissal.
Collect any authentication tokens. Terminate access to systems immediately
when an employee notifies the Department of
a resignation that is on unfriendly terms.
Retrieve any access cards or Departmental
identification badges.
Notify support functions (e.g., help desk) that
an employee is no longer authorized access.
Recover all keys. Restrict the area and function of employees
during the period between termination and
leaving.
Brief employee on continuing confidentiality
and privacy responsibilities.
Immediately notify the Project Officer,
appropriate NIH security officials, and the
assigned IT Systems Manager of the time of
removal.
Review any employee contracts that remain
valid after separation.
Request the Project Officer to have the
combinations changed on all locks to which the
contractor employee has access.
Return property belonging to the United
States Government.
Collect any authentication tokens.
Identify any unique problems, filing
schemes, or data backups created by the
employee.
Retrieve any access cards or Departmental
identification badges.
Instruct employees on proper “clean up”
procedures for their personal computers
(PC) before leaving.
Recover all keys.
Determine the employee’s access
termination date, and notify the Project
Officer, appropriate NIH security officials,
and the assigned IT Systems Manager
within 24 hours of the time of termination.
Review the employee’s duties and
responsibilities under this contract with the
Project Officer and assess the level of risk to
the Government.
Notify the Project Officer in writing upon
completion of these actions.
Escort individual off premises in cases where
the potential for retaliation is high.
Notify the Project Officer in writing upon
completion of these actions.
CERTIFICATION: By signing below, I certify that the above actions were taken on the dates indicated.
__________________________________ _______________________________________________
Typed Name of Individual Authorized to Certify for Contractor
______________________________________________
Title of Individual Authorized to Certify for Contractor
Signature and Date
