I used one from aupairmom several years ago, in an acrimonious departure situation (I came home early and had caught AP screaming at my then-seven year old - child was cowering in the corner and had peed in her pants from fear - it was awful). I just looked for it and can't find it, but I did find this post:
http://aupairmom.com/settling-accounts-before-she-departs/2009/08/17/celiaharquail/
I'll keep looking, and if I can find it, I'll post it. It went through all the areas that AP needed to tie up/clean up and was very helpful. It also helped me be very professional with this total &^%^ of an AP.