TERMINATION CHECKLIST Employees Name: Date: BENEFITS DISCUSSED Group Insurance Conversion Vacation Eligibility Retirement Plan Unemployment Insurance Severance Pay (if any) RETURN OF PROPERTY CREDIT CARDS KEYS Car Rental Office Telephone Computer Other: Files Desk EQUIPMENT Dictation Calculator Computer MANUALS, BOOKS, DOCUMENTS, ETC. Policy Manual Client List Computer Books/Manuals IDENTIFICATION/SECURITY PASSES SECARD FOR ADMINISTRATION USE ONLY: COBRA Letter Sent? (Y/N) Terminate Ins. - Accounting Dept. Life/Disability Insurance Diary Calendar for Employees Conversion Letter Sent? COBRA Decision Employees Signature Administrator Signature