Separation Checklist
Adams Stirling PLC
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SEPARATION CHECKLIST

Employee:________________________________________________

Last Day of Work:_______________

The following items were returned:

    ___ Keys        ___ Jacket     ___ Ties           ___ Pants
    ___ Beeper     ___ Shirt       ___ Rain Gear   ___ Radio   ___ other

Describe Details of Exit Interview:


THE FOLLOWING MATERIALS WERE GIVEN OR MAILED TO FORMER EMPLOYEE:

   ____ COBRA Letter & Election form

   ____ HIPP Letter

   ____ State Disability Insurance Provisions (EDD Pamphlet)

   ____ California's Programs for the Unemployed

THE FOLLOWING WAS COMPLETED:

   ____ Change in Status Form

   ____ Delete person from health, dental and life insurance policies


Signature:_____________________________________   Date:__________

ASSISTANCE: Associations needing legal assistance can contact us. To stay current with issues affecting community associations, subscribe to the Davis-Stirling Newsletter.

Adams Stirling PLC