EXIT INTERVIEW FORM
Employee Name Immediate Head
Dept. / Location Job Title
DOJ DOL
1. Why are you leaving this Organization?
2. What circumstances would have prevented your departure?
p3. What did you like most about your job?
4. What did you like least about your job?
5. What did you think of your immediate head on the following points?
Always Usually Sometimes Never
Was consistently fair ( ) ( ) ( ) ( )
Provided recognition ( ) ( ) ( ) ( )
Resolved complaints ( ) ( ) ( ) ( )
Was sensitive to employees' needs ( ) ( ) ( ) ( )
Provided feedback on performance ( ) ( ) ( ) ( )
Was receptive to open communication ( ) ( ) ( ) ( )
Human Resources
6. How would you rate the following?
Excellent Good Fair Poor
Cooperation within your Department ( ) ( ) ( ) ( )
Cooperation with other departments ( ) ( ) ( ) ( )
Personal job training ( ) ( ) ( ) ( )
Company's performance review system ( ) ( ) ( ) ( )
Company's new employee Induction Programme ( ) ( ) ( ) ( )
Rate of pay for your job ( ) ( ) ( ) ( )
Career development/Advancement opportunities ( ) ( ) ( ) ( )
Physical working conditions ( ) ( ) ( ) ( )
Comments:
7. Was the work you were doing approximately what you expected it would be?
( ) Yes ( ) No
Comments:
8. Was your workload usually:
( ) Too heavy ( ) About right ( ) Too light
9. Would you recommend the company to a friend as a good organization to work for?
( ) Most definitely ( ) With reservations ( ) No
11. What suggestions do you have to make this organization a better place to work?
HR Representative: Signature of Employee
Date: Date:
Human Resources