Page 1 of 4 DESCRIPTION/OVERVIEW This procedure describes ...

Applies To: UNM Cancer Center
Component(s):
Responsible Department: All
Title: Employee Separation Checklist
Procedure
Patient Age Group: (x) N/A ( ) All Ages ( ) Newborns ( ) Pediatric ( ) Adult
DESCRIPTION/OVERVIEW
This procedure describes the process by which employees leaving employment relinquish Cancer
Center and hospital property prior to receiving their final paycheck.
REFERENCES
UNM HSC 3.1 – Workforce Security – ePHI
UNM HSC 3.4 – Termination and Transfer Policy – e PHI
UNM HSC 4.1 – Information Access Management – ePHI
UNM HSC 4.5 – Information Access Authorization, Establishment and Modification – ePHI
UNM HSC 6.1 – Security Awareness and Training - ePHI
AREAS OF RESPONSIBILITY
Each department manager will be responsible for ensuring that the “Separation Check-Off for
Staff Employees” is completed and each applicable element is addressed.
PROCEDURE
1. Employee will return all cell phones, pagers, calling cards to the manager.
2. Manager will request deactivation of long distance authorization code, cell phone, pager and
remove the individual’s access to voicemail by contacting Telecommunications at
http://fastinfo.unm.edu.
3. Employee will return purchasing card if applicable.
4. Employee will return UNM equipment to Property Accounting if applicable.
5. Employee will return radiation badge to Radiation Oncology if applicable.
6. Employee will return parking permit to Parking Services.
7. Employee needs to check with the circulation desk at the General Library or Health
Sciences Library.
8. Employee must return all keys to the Lock Shop.
9. Employee must check with the Bursar’s Office.
10. Employee must check with Human Resources to:
10.1. Obtain insurance benefits information,
10.2. Complete exit interview (can be completed on-line),
10.3. Return UNM identification badge,
10.4. Complete retirement reimbursement form if applicable.
11. Manager will alert Medical Informatics and Technical Support Group (MITS) by e-mail and
in person, as evidenced by signature on “Separation Check-Off for Staff Employees,” that
access to all applicable computer applications has been removed.
12. Employee will return completed Check-Off form to manager for final signature.
13. Manager routes original form to Human Resources and a copy to payroll.
Title: Employee Separation Checklist
Owner: Clinical Operations Director
Effective Date: 12/22/08
Page 1 of 4

14. The employee is responsible for obtaining the signatures from all applicable receiving
departments.
DEFINITIONS
None
SUMMARY OF CHANGES
Replaces document of the same title, effective 9/07
RESOURCES/TRAINING
Resource/Dept
Administration
Human Resources Representative
Internet/Link
DOCUMENT APPROVAL & TRACKING
Item Contact Date Approval
Owner
Clinical Operations Director
Lori Anderson, HR Representative
Stanton Royce, Compliance Officer
Consultant(s)
Beth Freshman, Supervisor, Clinical Administrative Support
Sandi Peacock, Nurse Manager
Committee(s)
UNM Cancer Center Policy, Procedure and Guideline Committee
UNM Cancer Center Clinical Operations Group
Nursing Director Sandi Peacock, RN, MBA, Nurse Manager Y
Medical Director Ian Rabinowitz, MD, Clinic Medical Director Y
Human Resources Lori Anderson, HR Representative Y
Finance [Name, Title], [UNMH or HSC] [Y or N/A]
Legal [Name, Title], [UNMH or HSC] [Y or N/A]
Official Approver Don Whitehead, Chief Operations Officer and Clinic Administrator Y
Official Signature
Effective Date 12/22/08
Origination Date 9/21/07
Issue Date
Clinical Operations P&P Coordinator
ATTACHMENTS
Separation Check-Off List for Staff Employees
Y
Title: Employee Separation Checklist
Owner: Clinical Operations Director
Effective Date: 12/22/08
SEPARATION CHECK-OFF LIST FOR STAFF EMPLOYEES
Last Revised: 11/26/08
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NAME_________________________________________________BANNER ID #__________________
DEPARTMENT________________________________DEPARTMENT
PHONE________________________________
FORWARDING MAILING
ADDRESS:____________________________________________________________________________
HOME PHONE (______)_____________________
1.*Manager: Submit UNM Staff Employee Separation
Form to Human Resources
Has employee turned in the following items to you? If
applicable: Cell phone____Pager____
Calling Card____ Computer Applications ____
Please request deactivation of calling card, long distance authorization
code, cell phone and/or pager and remove the individual's access to
voicemail. This can be accomplished by contacting Telecommunications
at telecom@unm.edu.
2. Purchasing or Health Sciences Controller's Office
(if applicable)
Sign here:
Turn in:
A. Purchasing Card _______
3. Property Accounting-Turn in University equipment
Sign here:
(if applicable)
4..Risk Management Department (if applicable)
A. Turn in radiation badge ____
Sign here:
B. +Close out procedure for chemical/biological
agents ____
5. Parking Services-Parking Permits (required) Sign here:
6. General Library or Health Sciences Library for
Sign here:
HSC employees-Circulation Desk (required)
7.**Physical Plant Lock Shop-Turn in keys (required) Sign here:
8. Bursar's Office (required) Sign here:
9. University Department of Human Resources
(required):
A. Obtain Insurance Benefits Information____
Sign here:
B. ++Complete Exit Interview____
C. Return UNM ID - Benefits Office____
D. Complete Retirement Reimbursement Form____
10. Return Completed Check-Off List Sign here:
AUTHORIZED SIGNATURE
Employee's Supervisor
Health Sciences Center employees must return this form to the University Health Sciences Department of
Human Resources after completion. All other employees must return the form to the University Payroll
Department.
• *The UNM Employee Separation form and this Check-Off List should be started at least ten (10)
working days in advance of the separation date or as soon as the department becomes aware that an
employee is separating. The manager may sign-off indicating N/A for those areas that are not
applicable. If the area indicates the signature is required, the employee must obtain the required
signatures.
Title: Employee Separation Checklist
Owner: Clinical Operations Director
Effective Date: 12/22/08
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• **The following departments should continue their present procedure for turning in keys:
NMERI/Children's Psych Center/Physics & Astronomy/Mental Health Center/Housing/New Mexico
Union/Branch Campuses.
• +If you work with materials of a chemical or biological nature, please call the Risk Management
Department 10 (ten) days prior to your departure for close-out procedure.
• ++The exit interview is not required but the information you provide is helpful to UNM in
determining trends and will only be used to analyze and report those trends as a part of summarized
data. The information will not be released to your manager/supervisor. If you prefer, you may
submit the interview anonymously; you are not required to provide your name. You may access the
exit interview at: http://www.unm.edu/~hr/current staff/.
• If you are interested in retirement reimbursement, please contact the University Payroll Office.
Comments may be sent to UBPPM@UNM.edu
http://www.unm.edu/~ubppm
Contents
Section 3000
Contents
Policy Listing Forms Index
UBP Manual
Homepage
UBP Homepage UNM Homepage
Title: Employee Separation Checklist
Owner: Clinical Operations Director
Effective Date: 12/22/08
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