Exit Feedback Form
Name
First Name
Last Name
Supervisor
First Name
Last Name
Manager
First Name
Last Name
Department/Client
*
Hire Date
*
-
Month
-
Day
Year
Date
Resignation Effective Date
*
-
Month
-
Day
Year
Date
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I. Element Evaluation
The table below is designed to measure which areas of concern were most important to you in your decision to leave the company, the higher the number, the more weight given.
*
Rows
(5) Most Important Reason
(4) Considered fairly important
(3) Has some bearing in my decision
(2) Very little influence
(1) Not involved in decision
Salary
1
2
3
4
5
Company Benefits
6
7
8
9
10
Relationship with Managers
11
12
13
14
15
Advancement Opportunities
16
17
18
19
20
Job Location
21
22
23
24
25
Relationship with TLs; Supervisor
26
27
28
29
30
Job Challenge
31
32
33
34
35
Hours of Work
36
37
38
39
40
Work Load
41
42
43
44
45
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II
These questions will help us address areas that need improvements in our company. Please rate your reactions according to the following points system: (5) Excellent (4) Good (3) Satisfactory (2) Fair (1) Poor
*
Rows
(5) Excellent
(4) Good
(3) Satisfactory
(2) Fair
(1) Poor
How would you rate this company as a place to work?
46
47
48
49
50
What is your overall view of the company's policy and procedures?
51
52
53
54
55
How do you rate the working conditions and physical facilities?
56
57
58
59
60
Compared with other companies, how do you rate our benefits package?
61
62
63
64
65
How do you feel about the management's willingness to hear complaints and make changes?
66
67
68
69
70
How would you rate the initial training you received?
71
72
73
74
75
How do you rate subsequent training opportunities to improve your skills and opportunities?
76
77
78
79
80
How well did you understand the performance standards you were expected to meet?
81
82
83
84
85
How well were you informed about changes that affected your work?
86
87
88
89
90
How much of a chance do you feel you had to develop your full potential?
91
92
93
94
95
How do you rate your supervisor's willingness to answer questions and help solve problems?
96
97
98
99
100
To what extent were you encouraged to offer suggestions and improvements?
101
102
103
104
105
What level of respect did you hold for your supervisor?
106
107
108
109
110
How would you rate the spirit of cooperation and teamwork among the employees in your department?
111
112
113
114
115
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III.
Please rate the following based on how you have experienced them within the duration of your stay with Pen Brothers. You may refer to the guide provided below. Likewise, kindly provide a substantial written assessment to support the rating. (1) Extraordinary (2) Very Good (3) Good (4) Fair (5) Marginal (6) No basis
Relationship with peers (rate and describe)
*
Relationship with immediate supervisor (rate and describe)
*
Relationship with the department you belong (rate and describe)
*
View of the over-all management group and the dynamics it bring (rate and describe)
*
View of general employee behavior, facilities and working conditions (rate and describe)
*
View of dynamics and levels of communication within the organization (rate and describe)
*
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IV
Please provide answers as truthfully as possible. Everything written here will be held with the strictest confidentiality and shall be used as company reference in fine-tuning systems and procedures and for the continuous development of better working environment for its employees.
If there are future opportunities for you within our company, would you consider being reprofiled to a different client?
*
Yes
No
If there are future opportunities for you within the same client, would you consider working for the company again?
*
Yes
No
Reason For Leaving
Signature
*
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