Clearance Checklist: For All Employees Before completing this clearance, submit a Personnel Event Form or DHRS on-line document to appropriate Human Resources or Faculty Affairs Office, attaching resignation letter, layoff notification letter, termination letter, leave of absence request or any other documentation concerning the separation. This form should be initiated as soon as the separation is announced and must be submitted to the appropriate office as soon as all sections are completed. THIS FORM SHOULD NOT BE USED WHEN EMPLOYEES ARE TRANSFERRING TO ANOTHER DEPARTMENT. A final paycheck will not be issued until this form is completed and submitted to Check Distribution Last Name: Rank or Title: Department: First Name: UM ID #: Employee’s Check Distribution Code: Date of Separation: Campus: Faculty Research Administrative Professional Clerical, Technical & Service To be completed by Department Head (or designated Administrative Official): Classification and Campus Clearance Needed From Employee Benefits Medical, Rosenstiel, & Gables Payroll IT Security Telecommunications Action Required Complete the online Clearance Form (Provide termination/layoff date) found at http://www.miami.edu/index.php/benefits_administration/separation_from_ the_university/benefits_clearance_request . The employee should contact HR-Benefits at 305-284-3004 for important information regarding their benefits. To cancel direct deposit, send an email to [email protected]. To ensure all IDs managed by IT security are deactivated, send an email to [email protected] or fax the Clearance Checklist to 305-284-9335. Authorized By (Assistant Director/Alternate) Date N/A To disconnect telephone lines, sets, long distance security codes, network access services, DSL Service and AT&T Line/Services, a TSR (Telecommunications Service Request) must be submitted to the Telecommunications department. The form can be emailed ([email protected]), faxed (305-284-5809) or sent by interoffice mail to Telecommunications Dept., Gables One locator code 2921 (please do not send the Clearance Checklist to Telecomm IT Support Center/Telecomm). If you have any questions, please contact the IT Support Help Desk at 305-2846565, option 2. 1 of 4 Revised: 10/8/2014 Classification and Campus Clearance Needed From Libraries As appropriate Student Account Services Disbursement Office Corporate Cards Purchasing Department Head Department Head Department Head Facilities Management Gables & Rosenstiel Only Access Control Parking Medical Human Resources Records Medical Information Technology Action Required (A) Richter Library : Complete online Clearance Form at http://library.miami.edu/library-clearance-form (B) Calder Memorial Library: Call 305-243-6403 (C) Marine Library: Call 305-421-4060 Send an email to [email protected]. For Petty Cash or Travel Advance, submit email to [email protected]. Authorized By (Assistant Director/Alternate) Date N/A For AMEX Purchasing, AMEX Corporate Card or US Bank Travel Card, call 305284-2417 or send an email to [email protected]. Contact for clearance only if this employee has access to UM eNet Ariba system. Call 305-284-5115. Office Keys, Lab Space, Computer Access Codes, Equipment, Uniforms, Petty Cash, Reconciliation, Travel Advance/Expense Reports Outstanding, other department closeout procedures, etc. Review web pages upon termination of employees for any web presence and update accordingly. Recover ID Cards (i.e. Cane Card) from employee and forward to the Cane Card Office located on the first floor of the McKnight Building, 5807 Ponce de Leon Boulevard, Suite 100. Please submit service request via www.miami.edu/sro to initiate this process. To ensure all electronic access is deactivated (Onity and CBORD) and metal keys are collected. *Note: it is the responsibility of the department to collect all issued keys and Cane Card N/A Gables: Send an email to [email protected] indicating name, C# and termination/layoff date. Medical: Parking/Security (after 1 p.m.) For building access cards and keys call 305-243-6280. Submit copy of termination/resignation letter to fax 305-243-6503. Send an email to [email protected]. 2 of 4 N/A Revised: 10/8/2014 Classification and Campus Clearance Needed From Medical Hospital Only Pharmacy Services UChart Property Control Medical, Rosenstiel, & Gables Rosenstiel & Gables Only Medical Only Research/Sponsored Programs As appropriate Environmental Health/ Safety Radiation Control Center JMH/PHT Health Information Management UMHC/SCCC Health Information Management Action Required To cancel access to the Pyxis MedStation system for any employee who had access, please email the clearance list or name of employee who is no longer employed with the University to the appropriate site of employment. Bascom Palmer/ABLEH: [email protected] UMHC/SCCC Deerfield: [email protected] UMHC/SCCC Kendall: [email protected] UMHC/SCCC Miami: [email protected] UMHC/SCCC Plantation: [email protected] Authorized By (Assistant Director/Alternate) Date N/A To discontinue access, call 305-243-5999, Option 3. Call 305-284-4656. (A) (B) (C) (D) (E) (F) Gables/South – Pre-Award Administration, call 305-284-4541. Medical – Clinical Research Initiation Services (CRIS), call 305-243-7704. Medical – Pre-Award Administration, call 305-243-6232. Marine – Pre/Post Award Administration, call 305-361-4080. Gables/South – Post-Award Administration, call 305-284-2665. Medical – Post Award Administration, call 305-243-3825. Call 305-243-3400. *Requires a satisfactory closing inspection of the separating faculty member/researcher’s laboratories. The faculty member must consult Safety and Radiation Control Offices at least one month before separation concerning the scheduling of inspections. Call 305-243-6360. *Requires a satisfactory closing inspection of the separating faculty member/researcher’s laboratories. The faculty member must consult Safety and Radiation Control Offices at least one month before separation concerning the scheduling of inspections. Call 305-585-7305. Please note, for faculty this requires Medical Chart completion by full time attending physicians. For Medical Chart completion by full-time attending physicians, send an email to [email protected], [email protected], and [email protected]. Please provide name and C#. 3 of 4 Revised: 10/8/2014 Classification and Campus Clearance Needed From BPEI/ABLEH Health Information Management Animal Care and Use Committee Home Department Human Subjects Action Required Authorized By (Assistant Director/Alternate) Date Call 305-326-6189. Please note, for faculty this requires Medical Chart completion by full time attending physicians. Send an email to [email protected]. Please provide name, C#, and termination date. All UMMG faculty must complete the most recent quarter of the physician online time and effort report. Call 305-243-3195. Please not, faculty must submit a final report or transfer PI ship of ongoing clinical research trials prior to clearance. All personnel must be removed from ongoing studies prior to granting clearance. To be completed by the Departmental Administrative Official submitting this clearance form: Please note: by signing this form, the department certifies this checklist is complete and authorizes release of the employee’s final payroll check (per policy). Print Name: Title: Signature: Telephone: Department: Date: Forward this completed form via Interoffice Mail to the Check Distribution Office, 129 Ashe Building, Locator Code 4613 or by fax to 305-2846707. Check Distribution Acknowledgement: Signature: Final paychecks will be mailed to the address of record. Date: 4 of 4 Revised: 10/8/2014
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