LC INFRA PROJECTS PVT. LTD.
EXIT INTERVIEW FORM
In order to maintain a positive working environment at LC INFRA PROJECTS PVT. LTD., we request your cooperation inproviding
suggestions and comments to assist us in accomplishing this goal. You are a valuable source of information regarding working
conditions. Please be candid with your answers so we may gain from your experience here at LC INFRA PROJECTS PVT. LTD.This will not
become part of your permanent file. All information will remain confidential. Your comments will in no way affect your reemployment
possibilities should you desire to seek employment with us again.
Name:-
Position:-
Reporting to:-
DOJ:- DOL:-
A. Reason for leaving. Please check all that apply
Personal Quantity of work
Family Circumstances Working conditions
Health Reasons Problems with work schedule
Relocation More Pay
Higher education Benefits
Retirement Relationship with supervisor
Company policy Lack of training
Type of work Lack of promotional opportunity
Proposed Job near to home Other
Please explain
B. How would you rate your reporting authority on the following elements?
Excellent Good Fair Poor
1 Demonstrates fair and equal treatment
2 Facilitates cooperation and teamwork
3 Provides recognition on the job
4 Encourages feedback/listens to suggestions.
5 Effectively resolves complaints and grievances
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C. How would you rate the following in relation to your job?
Excellent Good Fair Poor
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Communications between you and your
manager
2 Morale in your department
3 Job satisfaction
4 Training you received
5 Growth potential
D. Job Feedback
11 To what extent did you have the opportunity to use your abilities while working here?
12 Was the job you performed the one you applied for?
yes No
13 Do you feel you were delegated the appropriate responsibility?
yes No
14 What were some of the frustrations you experienced in the performance and execution of your
job responsibilities ?
15 What circumstances would have prevented your departure?
16 What suggestions do you have for the future of this position?
17 What constructive comments would you have for management in regard to making your
department a better place?
E. Final Comments
1 Are there any comments you would like to make (including comments on this survey)?
Thank you for providing feedback on your work experience. The information will help Human Resources evaluate how to
improve organisation policy. Your name and personal comments will be kept confidential
Employee Signature: Date:
Job title: Department
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