West Virginia Department of Health and Human Resources

                                                 Checklist for Departing Employees

Item Completed Returned
Paper Work    
Resignation Notice/Acknowledgement    
Resignation Information/Payroll Form - WV 11    
Interviewer Exit Survey    
Employee Exit Questionnaire submitted on-line    
WV P.E.I.A. Forms    
Consolidated Public Retirement Board Forms    
Performance Evaluation Form    
Back-belt Return or Replacement Form    
Training and Employment Record Form (for Health Service Worker/Trainee only)    
Request for Reception (if applicable)    
Employee Handbook    
Signature Cards    
Final Time Sheet    
RCAF Termination    
Cards    
Telephone Calling Card    
Travel Credit Card    
Employee ID Card/Case    
Employee Parking Card/Sticker    
Employee Security Door Card    
WeSave Card    
Automobile    
Automobile    
PHH Card    
Turnpike Toll Card    
Office Keys    
Door keys    
File cabinet keys    
Diskette box keys    
Personal computer keys    
Passwords    
Telephone    
Computer    
Computer equipment & supplies    
Personal computer    
Laptop computer    
Diskettes    
Software    
Software manuals    
Palm-pilot    
Office Supplies    
Manuals (in-house and State)    
Dictating/transcribing equipment    
Calculator    
Date/Address/Draft stamps    
Hand-held Recorder    
Pager    
Cellular telephone    
Briefcase    
Books (reference, training. etc.)    
Other    
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OPS - 7C Revised 01/03