Checklist

Return of State Property

Upon Separation from NYSDOT
All of the following items must be collected by the immediate supervisor and processed as
directed below. The employee and the supervisor must sign and date this checklist, attesting
that all checked property has been returned. RETURN ORIGINAL FORM TO: Main Office:
Personnel Bureau. Or Regional Offices: Administrative Services Office, to be filed into
the employee’s PHJ.

Office
Done Item Process/Requirements Contact Information

Parking Permits Return to issuing office. MO – Audit and Civil Rights

And, Photo ID cards 50 Wolf Rd, 6th Floor South
(518) 457-6446
Region-Administrative Office
Keys to office, desk, Return to Your Supervisor
to either return to Administration MO – Facilities Management
or reassign. Supervisor 50 Wolf Rd, 1st Floor South
MUST inform Administration. (518) 457-1587
of the change. Region– Administrative Office
Phone Calling Card(s) Delete authorization codes MO-Office of Information Services
Delete vendor telephone 50 Wolf Rd, 2nd Floor
calling card. (518) 457-2800
Region-Administrative Office

Voicemail/Passwords Reassign or delete voice mail MO-Help Desk

boxes. Delete passwords or 50 Wolf Rd, 2nd Floor
leave with supervisor. (518) 485-8111
Region-Administrative Office
Telephone Sets Turn in unused telephone sets MO-Help Desk
& adjuncts for recycling if a 50 Wolf Rd, 2nd Floor
line is deactivated. (518) 485-8111
And, Toll Free Numbers Reassign/delete toll free Region-Administrative Office
dialing services.
Cellular Telephone Return to supervisor who will MO-Help Desk
&Pagers give to program area Inventory 50 Wolf Rd, 2nd Floor
Coordinator who sends it to (518) 485-8111
MO ISB. If equipment is Region – Administrative Office
redeployed within Program area,
inform.
Credit cards VISA/AMEX card turned into the MO –Accounting Bureau-Travel
Travel Unit. Makes sure all VISA 50 Wolf Rd, POD 52
charges are cleared. Make sure (518) 457-0817
all outstanding advances are Region – Administrative Office
cleared or returned.
Exit Interview Survey Supervisor to inform employee that this is available Office of Human Resources
And must be done electronically at: 50 Wolf Road
https://www.surveymonkey.com/s.aspx?sm=I4kNDPpSZoMnQxk4W6AsEA_3d_3d (518) 457-7043

Updated 12-3-2008 OHR

 Office
Done Item Process/Requirements Contact Information

Badges- Return to your supervisor OMSS Badges and MO Office of Modal Safety &Security Services
And Security Services PTSB and Investigator Badges 50 Wolf Road, 5th Floor, POD 53
(518)457-6512
PC/Monitor and Work through your supervisor MO-Region - Help Desk
related equipment, & IT Coordinator to facilitate (518) 485-8111
laptop, printer, return of this equipment to the Region – Regional IT Coordinator
projector Help Desk. PC/Monitor/Printer
is the responsibility of the IT
Coordinator.
PDA-(Personal Digital Return this equipment to your MO- Help Desk
Assistant)- i.e. Palm Pilot, supervisor or program’s IT (518) 485-8111
HP Jornado, Blackberry. Coordinator. Region - Regional IT Coordinator

Novell Account Cancel accounts MO Region- Help Desk

NT Domain Account Work through your supervisor (518)485-8111
GroupWise Account and IT Coordinator to delete Accounts Region – Regional IT Coordinator
Main Frame Account
TADS
Other specialized
account w/ system access.
Computer Passwords Cancel passwords MO/Region - Help Desk
Power on Password Delete from computer(s) work (518) 485-8111
through your supervisor and IT Region – IT Coordinator
Coordinator to delete accounts
Computer Files Work through your supervisor and IT MO/Region - Help Desk
Coordinator to transfer or delete electronic (518) 485-8571
files as appropriate. Save to CD-especially
if on private drive. Turn in to your supervisor any
disks, which contain confidential DOT data.
Any confidential files from your home PC
should be copied to disk, turned in to your
Supervisor, and deleted from your home PC.
Return any copies of confidential paper/
documents. Transfer computer (including
PDA) and paper file ownership to supervisors
designee.
Employee Handbook Employee returns to MO- Personnel Bureau
Personnel Bureau 50 Wolf Rd, 1st Floor South
Administrative Services (518)457-6460
Region– Administrative Office

Agency Library Books Return to appropriate office MO - Transp. Research & Dev’t.
General books & 50 Wolf Rd, 3rd Floor
manuals (518) 485-2077
MO - Learning Resource Center
50 Wolf Rd, 1st Floor
(518)457-2942
Region– Appropriate office

Updated 12-3-2008 OHR

 Office
Done Item Process/Requirements Contact Information

Other DOT property Return to appropriate office. MO/Region- Check with

check with assigned to employee: supervisor or office manager.
i.e. survey equipment,
tools, manuals, safety
equipment, etc. [list below]

__________________________________ __________________________________

__________________________________ __________________________________

__________________________________ __________________________________
Address & phone no. Verify home address & phone Your office and/or
verification. Number w/your office and MO- Personnel Bureau
Personnel/Admin. Services for (518) 457-6460
future necessary contact about Region – Admin. Services
paychecks & W2’s.
Web Pages- Intra DOT Remove name from websites Web central or your office
& web page directories. Automation Coordinator.
Member of Evacuation If you are an evacuation staff MO- Employee Safety & Health
Staff member, please inform your 50 Wolf Rd , 1st Floor
Building Captain or your (518) 457-2420
Regional Safety Representative Region - Regional
Safety Representative

Incident Command Ctr If you are a trained volunteer for Office of Operations
volunteer the ICC, notify Office of (518) 485-1379
Operations

List Services Notify owners of the listservs As warranted

on which you are a member
to change or delete your e-mail
address.

Sign below to attest that the appropriate action(s) have been taken on all items checked above, and that this is a complete list of the
State/DOT property assigned to the separating employee.

___________________________________________________________
Employee Name (Print)

_____________________________________ ______________________________
Employee Signature Date

____________________________________________________________
Supervisor Name (Print)
_____________________________________ _______________________________
Supervisor Signature Date

Related Authoritative Source:

MAP 2.4-1-3: http://axim22.nysdot.private:7779/pls/portal/INTRADOT.arms_maps_display.show_doc?p_id=1003
PHJ FILE Original
Employee Copy
Supervisor Copy
Updated 12-3-2008 OHR