Exit Interview Checklist
Exit with Insight: Your Feedback Matters!
Employee Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Departmant
Position
Reasons for Termination
1
Accepting another job
Education
Relocation
Retirenment
Pregnancy
Employee health
Family health
Other
2
Never
Often
Frequently
How frequently did you get performance feedback?
3
4
5
How frequently did you have discussions with your manager about your career goals?
6
7
8
Do you have any suggestions for improvement?
Submit
Should be Empty: