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Exit Interview Feedback Form

The document appears to be an exit interview questionnaire for an employee leaving a company. It collects information about the employee's reasons for leaving, their level of agreement with statements about their supervisor, work environment, development and recognition. It also asks for feedback on what could have prevented their departure, the company's barriers to success, strengths, and whether they would return or recommend the company. The questionnaire will be treated confidentially and used to help the company improve.

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Agan Uphi
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784 views2 pages

Exit Interview Feedback Form

The document appears to be an exit interview questionnaire for an employee leaving a company. It collects information about the employee's reasons for leaving, their level of agreement with statements about their supervisor, work environment, development and recognition. It also asks for feedback on what could have prevented their departure, the company's barriers to success, strengths, and whether they would return or recommend the company. The questionnaire will be treated confidentially and used to help the company improve.

Uploaded by

Agan Uphi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CONFIDENTIAL

EXIT INTERVIEW QUESTIONNAIRE

Employee Name Date of Hire


Department Today’s Date
Position Direct Supervisor

Please be open and candid in answering the below question as we will use your
input for our improvement. Your data will be treated in a strictly confidential
manner. Thank you.

1. Your primary reason of leaving is (you may answer more than 1):
Bigger scope of  Better work-life  Start/run own business
responsibilities balance  Stay-at-home mother
 Better salary  Retirement  Other personal reason,
 Better benefits program  Relocation _________________
 Higher title/position  Continue study

2. Please put an “X” in column to reflect your agreement to the following statements:
Strongly
Strongly Agree
disagree

1 2 3 4
My role, job assignments and responsibilities were clearly
explained to me.
My supervisor and I discussed my work plan so that I would
Supervisor

understand what was expected of me.


My supervisor was consistently fair and receptive to open
communication.
I was given regular feedback on my performance.
I was provided enough materials/resources to perform my job.
Credo Values is evident in my supervisor’s behaviors and
decisions.

1 2 3 4
I had good teamwork in my work area.
Work Environment

I received good collaboration from other people in the company.


I was given room to make mistakes and try new ideas and
initiative
I feel the workload in my department was distributed fairly.
I feel that the same standard of discipline was applied to all
employees.
This company paid high attention to my health, safety, &
security.
Management understood the importance of work life balance.

1 2 3 4
My supervisor supported me in my development plan &
Developmen

activities.
t & Career

I received adequate training and development for the work I


was expected to do.
I think career/promotional opportunities were available for
deserving employees.

Exit Interview form -Last printed 7/8/2021 11:28:00 AM Page 1 of 2


1 2 3 4
I was satisfied and proud of the work I have done.
Recognition
Rewards &

I feel that I have contributed to the growth of this company.


I feel that the pay I received was fair for the work performed.

I feel that the benefits I received were adequate.


3. What circumstances would have prevented your departure?

4. Based on your opinion, what is this company’s greatest barrier to succeed?

5. What do you think needs to be done to overcome the above barrier?

6. What do you think is the strength of this company as a place to work?

7. Would you consider returning to this company in the future? Why?

8. Would you recommend this company to a friend as a good place to work?

Employee Signature Interviewer Signature

Exit Interview form -Last printed 7/8/2021 11:28:00 AM Page 2 of 2

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