Exit Interview
Template
Validated for use by
Goal: To create an exit interview form.
Why this is important: Organisations must collect feedback from employees when
they are about to exit for whatever reasons they are.
Where this can be used: HR department.
When this is used: When an exit interview needs to happen.
Who uses this: Anyone from the Human Resource department to conduct the exit
interview.
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Revisions
Revision No. - Revision date - Approved by
Revision No. - Revision date - Approved by
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Instructions: The exit interview should be completed on the employee’s last
day of employment. An exit interview should be performed by a
representative of human resources with every employee who resigns from
their position.
It should be explained to the employee that exit interview notes are taken to
enable [Company name] to monitor issues in the workplace. These notes
will be kept confidential.
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Exit Interview Questionnaire
Please answer the following questions as honestly as possible. It will only take not
more than 8-10 minutes. Your individual responses will be treated as confidential.
We believe your feedback here is very significant and will assist in analyzing our
employee retention and turnover. Thank you for your cooperation!
Name Employment Date
Department Termination Date
Position Manager
What prompted you to seek alternative employment?
[ ] Type of Work [ ] Quality of Supervision
[ ] Compensation [ ] Work Conditions
[ ] Lack of Recognition [ ] Family Circumstances
[ ] Company Culture [ ] Career Advancement Opportunity
[ ] Business/Product Direction [ ] Other: ______________________
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Before making your decision to leave, did you investigate other options that would
enable you to stay? [ ] Yes [ ] No
If "yes", describe :____________________________________________________________
__________________________________________________________________________
What did you think of your supervision with regards to the following?
Almost Sometimes Never Comments
always
Demonstrated fair and equal
treatment
Provided recognition on the
job
Developed cooperation and
teamwork
Encouraged/listened to
suggestions
Resolved complaints and
problems
Followed policies and
practices
How would you rate the following in relation to your job?
Excellent Good Fair Poor Comments
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Cooperation within your
department
Cooperation with other
departments
Communications in your
department
Communications within the
company as a whole
Communications between you
and your manager
Morale in your department
Job Satisfaction
Training you received
Growth Potential
Was your workload usually:
[ ] Too great
[ ] Varied, but all right
[ ] About right
[ ] Too light
How did you feel about your salary and the employee benefits?
Excellent Good Fair Poor Comments
Base Salary
Medical Plan
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Dental Plan
Vision Plan
Life Insurance
Paid-time-off
STD/LTD Plan
Stock Options
Other
Are there any other benefits you feel should have been offered?
[ ] Yes [ ] No
If "Yes", what? _____________________________________________________________
________________________________________________________________________
Any other comments on benefits? ______________________________________________
_________________________________________________________________________
How frequently did you get performance feedback?
________________________________
_________________________________________________________________________
_________________________________________________________________________
What were your feelings about the performance review process?
_______________________
_________________________________________________________________________
_________________________________________________________________________
How frequently did you have discussions with your manager about your career goals?
_______
_________________________________________________________________________
_________________________________________________________________________
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What did you like most about your job and/or this company?
___________________________
_________________________________________________________________________
_________________________________________________________________________
What did you like least about your job and/or this company?
___________________________
__________________________________________________________________________
_________________________________________________________________________
What does your new job offer that your job with our company does not?
_________________
_________________________________________________________________________
_________________________________________________________________________
Do you have any suggestions for improvement? Have you raised them in the past?
_________
_________________________________________________________________________
_________________________________________________________________________
Would you recommend this company to a friend as a place to work?
[ ] Yes, without reservations [ ] Yes, with reservations [ ] No
Additional comments about your job or this company
__________________________________________________________________________
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