Exit Interview Template

The document is an exit interview form designed to gather feedback from employees leaving the organization. It includes sections for personal information, reasons for leaving, ratings of job aspects, organizational factors, and supervisor evaluation. Additionally, it requests details about the new job if applicable, ensuring confidentiality of responses.

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Exit Interview Template

Uploaded by

sehgalakshita555

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as DOC, PDF, TXT or read online on Scribd

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EXIT INTERVIEW FORM

NAME:
JOB TITLE:
DIVISION / UNIT:
START DATE WITH ORGANIZATION:
START DATE IN POSITION:
SEPARATION DATE:
TOTAL LENGTH OF SERVICE:
REPORTING MANAGER :

1. Please describe the primary reason(s) you are leaving your current position.

2. Did dissatisfaction with any of the following factors influence your decision to YES NO
leave?

Type of work
Working conditions (setting, schedule, travel, flexibility)
Pay
Supervisor
Location
Cost of living in area
Commute

3. Please rate the following aspects of the job you are vacating. Use the 1 – 5 scale below.
1 2 3 4 5
Poor Very Average Above Excellent
poor average
Type of work performed
Fairness of workload
Salary
Working conditions
Tools and equipment provided
Training received
Co-workers
Supervision received
Level of input in decisions that
affected you
EXIT INTERVIEW FORM

4. Please rate the following aspects of the organization overall. Use the 1 – 5 scale below.
1 2 3 4 5
Poor Very Average Above Excellent
poor average
Recruitment process
New employee orientation
Training opportunities
Career development opportunities
Employee morale
Fair treatment of employees
Recognition for a job well done
Support of work-life balance
Cooperation within the a Hospital
Communication between
management and employees
Performance and development
planning and evaluation
Interest and investment in
employees
Commitment to customer service
Concern with quality and excellence
Administrative polices/procedures

5. Please rate your supervisor on the following factors. Use the 1 – 5 scale below.
1 2 3 4 5
Never Seldom Often Usually Always
Gave usable performance feedback
Recognized accomplishments
Clearly communicated expectations
Treated you fairly and respectfully
Coached, trained, & developed you
Provided leadership
Encouraged teamwork & cooperation
Resolved concerns promptly
Listened to suggestions & feedback
Kept employees informed
Supported work-life balance
Provided appropriate & challenging
assignments
EXIT INTERVIEW FORM

6. If you accepted another job, please complete

the following.
Name of new employer
Location of position
Title of position
Nature of work of position
Salary of position
What the new position and/or organization
offers that we do not.

Thank you for your candid comments. All responses will be kept confidential.

Signature of Employee: DATE :

Singh of HR Representative: ________________ DATE:

Singh of Managing Director________________________DATE:

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Exit Interview Template

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Exit Interview Template

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EXIT INTERVIEW FORM

6. If you accepted another job, please complete

Signature of Employee: DATE :

Singh of HR Representative: ________________ DATE:

Singh of Managing Director________________________DATE:

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