IMPORTANT:	The following checklist must be completed by an employee’s immediate supervisor or designee. If completed by a designee, the immediate supervisor maintains responsibility for the completion and appropriate distribution.

Notify by e-mail the IT Security Manager1, the City of Tulsa Security Department2 and the Service Desk at least two weeks prior to an employee exit/transfer.

This checklist is designed to assist with the exits/transfers of employees. The checklist is used to maintain accurate information and to minimize omissions/delays and information technology security risks during the transitioning process.

INSTRUCTIONS

Complete and save the checklist.

Send an electronic copy to the following (no signatures required):

IT Security Manager1

City of Tulsa Security Department2	(access@cityoftulsa.org)

Service Desk

Print the checklist and obtain the employee’s signature.

Copy the signed checklist and store in your records.

Deliver the signed checklist to Human Resources and request that it is stored in the employee’s personnel file.

Employee Name: Employee Number:

Current Date:	Effective Date of Exit/Transfer:

Reason for Separation:

Resigned Terminated Transferred Retired Other

TRANSFERRING EMPLOYEES

Employee returned the following City Information Technology equipment/supplies (check all that apply):

External Storage (thumb drive, USB hard drive, etc.)

NOTE: Ensure that employee does not remove departmental electronic data.

Camera

Cell Phone/Smart Phone

Pager

Laptop/Computer Equipment (all accessories – e.g., mouse, bag, keyboard, etc.)

Tablet

Radio

Voice Recorder

Other Item(s)_____________________

N/A

Comments:

NOTE:	All requests from transferring employees to removing data must be reviewed by the IT Security Manager1. This includes both personal and/or City data stored on external storage devices or on other City assets, including but not limited to contact lists, email, documentation, employee/citizen records, etc.

If a data transfer is requested, the Supervisor shall notify the IT Security Manager1 who will meet with the employee to examine the device and copy/remove any work-related product.

Complete the following (check all that apply):

Returned Department ID’s

Security Card Entry Key access to be modified

N/A

Security Card Entry Key access should be modified as follows:

Complete the following:

Office, Desk & File Cabinet Keys Returned

N/A

Complete the following:

Network and/or Computer access to be terminated and/or modified

N/A

Describe terminations/modifications to network/computer access {applications and/or shared access (e.g., Police TRACIS, Shared Drive Public Defenders Files, City of Tulsa Personnel Payroll, etc.)}:

EXITING EMPLOYEES

NOTE:	E-mail the IT Security Manager1 with any questions.

The following actions were completed by the Information Technology Department:

Terminated access to all computer systems, email accounts, ID’s and passwords

Set voice mail pass code to 4-digit phone number of exiting employee’s phone

Returned the following City Information Technology equipment/supplies (check all that apply):

External Storage (thumb drive, USB hard drive, etc.)

NOTE: Ensure that employee does not remove departmental electronic data.

Camera

Cell Phone/Smart Phone

Pager

Laptop/Computer Equipment (all accessories – e.g., mouse, bag, keyboard, etc.)

Tablet

Radio

Voice Recorder

Other Item(s)_____________________

N/A

Comments:

NOTE:	All requests from transferring employees to remove data must be reviewed by the IT Security Manager1. This includes both personal and/or City data stored on external storage devices or on other City assets, including but not limited to contact lists, email, documentation, employee/citizen records, etc.

If a data transfer is requested, the supervisor shall notify the IT Security Manager1 who will meet with the employee to examine the device and copy/remove any work-related product.

3.	Completed the following, as applicable:

Returned City Purchasing Card (P-Card)

Returned Id’s, badges, City-issued driver’s license, security card entry key, office, desk & file keys to City of Tulsa Security Department2

Returned parking-permit sticker and/or hangtag

Removed all personal items from the office and any other work station

Notified Payroll if final paycheck should be withheld pending compliance of employee exit requirements

Other:

Supervisor (or Designee) Comments:

Exiting/Transferring Employee Comments:

(If applicable, this area is for handwritten comments by the exiting/transferring employee when signing the form.)

_____________________________________	_____________________________________

Exiting/Transferring Employee Signature	Supervisor (or Designee) Signature

1Richard Jackson, IT Security Manager

2 City of Tulsa Security Department (access@cityoftulsa.org)