7.01b Separation Checklist - Exhibit

Document Type:      Exhibit
Number:                  7.01b
Effective:                 05-01-06
Revised:                  09-05-08
Legal References:     I.C. §§ 45-606


To Be Completed By Supervisor

EMPLOYEE NAME: __________

EMPLOYEE ID #: __________


DEPARTMENT: __________

When a regular employee separates from the City of Boise, the department supervisor is responsible for the following. Please check off each item that was completed, sign and return form to Human Resources for inclusion in the employee’s official personnel file.

  • Complete a Status Form and forward it to Human Resources. This should occur upon receiving the employee’s notice of seperation.
  • If the employee is resigning or retiring, forward the written resignation or retirement letter to Human Resources.
  • Encourage the employee to complete an exit survey.
  • Ensure that all City property is returned prior to the last day of employment.
  • Ensure all City purchasing and credit cards are returned to Purchasing.
  • Notify the central Payroll office of the employee’s final regular time, overtime, unused vacation leave, and/or compensatory time hours (non-exempt employees only) to be included in the final paycheck.
  • Ensure that any money owed to the City by the employee (payroll loans, telephone bills etc.) is paid back either by payroll deduction authorized by the employee or that other arrangements are made with the City’s accounting office to repay the money.
  • Ensure that any money owed to the employee by the City (mileage reimbursement etc.) is paid either by payroll or that other arrangements are made with the City’s accounting office to ensure payment is made.


The supervisor shall collect all City property at or before the time of separation, including but not limited to the following. Please check each item that was returned and the date it was returned.

  • City credit or purchasing cards Date returned: ________
  • City uniforms or clothing Date returned: ________
  • Cell phones and/or pagers Date returned: ________
  • Employee identification badge Date returned: ________
  • Employee SIDA badge (Airport) Date returned: ________
  • Keys to City vehicles and buildings Date returned: ________
  • Laptops, Thumb Drives, PDAs, etc. Date returned: ________
  • Tools or other equipment Date returned: ________
  • City issued parking permit Date returned: ________
  • Citrix key fob Date returned: ________

All in-home City services were terminated and City equipment returned on what date?

Supervisor verified that the employee’s personal smart phone, PDA, thumb drives, etc. were cleaned of City information by IT on what date? ___________

List all other City property in possession of the employee and date returned:

Once you have completed this checklist please print and sign your name and submit to Human Resources for inclusion in the employee personnel file.

Supervisor’s Printed Name: ___________

Supervisor’s Signature: ___________

Date completed: ___________

CC: Employee Personnel File

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