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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 etk.payroll@miami.edu.
To ensure all IDs managed by IT security are deactivated, send an email to
security@miami.edu 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
(telecomhelpdesk@miami.edu), 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.
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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 saccounts@miami.edu.
For Petty Cash or Travel Advance, submit email to disbursements@miami.edu.
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 pcard.ap@miami.edu.
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 parking.gables@miami.edu 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 help@med.miami.edu.
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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: sgonzale@med.miami.edu
UMHC/SCCC Deerfield: mquinio@med.miami.edu
UMHC/SCCC Kendall: vmuro@med.miami.edu
UMHC/SCCC Miami: gfonte@med.miami.edu
UMHC/SCCC Plantation: rneerpat@med.miami.edu
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 kcarr2@med.miami.edu, whazel@med.miami.edu, and
vxm143@med.miami.edu. Please provide name and C#.
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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 iacucsupport@med.miami.edu. 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:
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