Exit Interview Questionnaire

Exit Interview Questionnaire
We would appreciate you taking a few minutes to answer the following questions as honestly as possible. Your individual responses are treated as confidential, and will not become part of your personnel file. We believe that the information is of vital importance and will assist in analyzing our employee retention and turnover. Thank you for your cooperation!
Your Name
First NameLast Name
Position
Last Working Date
MonthDayYear
Date
Job and Role
What influenced your decision to leave your position?
Type of WorkReturning to SchoolRate of PayLack of RecognitionRelocationConflict with Other EmployeesSupervisionCommuting DistanceFamily CircumstancePersonal CircumstanceRetirementOther
How would you rate your overall job satisfaction during your time with the company?

1
2
3
4
5
1 is Very Dissatisfied, 5 is Very Satisfied
Were your responsibilities and expectations clearly communicated to you?
YesNoPartially
Did you receive adequate training and support to perform your job effectively?
YesNoPartially
Work Environment
How would you rate the work culture and environment in the company?
ExcellentGoodFairPoorVery Poor
Were there any workplace issues or conflicts that influenced your decision to leave?
YesNoNot Applicable
Did you feel your contributions were recognized and appreciated?
YesNoPartially
Please rate the followings:
Cooperation within your department

1
2
3
4
5
1 is Worst, 5 is Best
Cooperation within other departments

1
2
3
4
5
1 is Worst, 5 is Best
Communications within the Company overall

1
2
3
4
5
1 is Worst, 5 is Best
Communication with you and your manager

1
2
3
4
5
1 is Worst, 5 is Best
Morale in your department

1
2
3
4
5
1 is Worst, 5 is Best
Management and Leadership
How would you rate the effectiveness of your immediate supervisor/manager?
ExcellentGoodFairPoorVery Poor
Were your career goals and aspirations discussed with your supervisor?
YesNoNot Applicable
Please rate the followings:
Medical Plan

1
2
3
4
5
1 is Worst, 5 is Best
Dental Plan

1
2
3
4
5
1 is Worst, 5 is Best
Vision Plan

1
2
3
4
5
1 is Worst, 5 is Best
Retirement Fund

1
2
3
4
5
1 is Worst, 5 is Best
Life Insurance

1
2
3
4
5
1 is Worst, 5 is Best
Vacation

1
2
3
4
5
1 is Worst, 5 is Best
Paid Sick Time

1
2
3
4
5
1 is Worst, 5 is Best
Base Salary

1
2
3
4
5
1 is Worst, 5 is Best
Bonus Salary

1
2
3
4
5
1 is Worst, 5 is Best
Suggestions and Feedback
What suggestions do you have for improving the workplace or your specific department?
Is there anything specific the company could have done to retain you as an employee?
Final Thoughts
On a scale of 1 to 10, how likely are you to recommend this company to a friend or colleague?

1
2
3
4
5
6
7
8
9
10
1 is Worst, 10 is Best
Any final comments or thoughts you would like to share about your time with the company?
Should be Empty: