Format: Exit Interview Form


Name of Employee: ___________________________   Position: _________________________________

Department: _________________________________   Reports to: ______________________________

Commencement date: _________________________   Termination date: _________________________

Date of interview: ____________________________

Feedback provided to manager:

Date: ____________________________________  Signed: ___________________________________


  1. What things make this a good place to work?__________________________________


  1. What things would you change to make this a better place to work? ______    ____________________________________________________________________________________
  2. Please indicate your reasons for leaving:q      Further study
    q      Family commitments
    q      Planning to travel
    q      Flexibility/wanting to work freelance
    q      Wanting a change
    q      New career opportunity
    q      Dissatisfied/disillusioned with current role
    q      Other
  5. If you have accepted a new position – describe the areas that make the new job more attractive.____________________________________________________________________________________________________________________________________________________________
Reasons for leaving

  1. How would you describe the culture here?q      Supportive
    q      Professional
    q      Relaxed/informal
    q      Friendly/welcoming
    q      Bureaucratic
    q      Competitive
    q      Hardworking
    q      Team-based
    q      Conservative
    q      Other ____________________________________________________________________



Job satisfaction


  1. On a scale of 1-5, how would you rate your overall job satisfaction?

1                             2                    3                   4                  5
Low level satisfaction                                                                                         High level satisfaction
q              q              q              q              q

  1. How did the following issues impact on your job satisfaction?
    Negative impact                   Positive impact
    1 2        3        4        5
    Remuneration                                                          q      q      q      q      q
    Type of work                                                           q      q      q      q      q
    Level of responsibility                                                         q      q      q      q      q
    Feedback                                                                q      q      q      q      q
    Changing nature of the job                                         q        q      q      q      q
    Support from manager                                              q      q      q      q      q
    Support from peers                                                  q      q      q      q      q
    Work pressure                                                                   q      q      q      q      q
    Communication – quantity                                           q      q      q      q      q
    Communication – quality                                            q      q      q      q      q

Involvement in decision making                                   q      q      q      q      q
Technology                                                              q      q      q      q      q

Managers enthusiasm/involvement                               q      q      q      q      q

Other ________________________________________    q      q      q      q      q




  1. What changes could have been made to improve your job satisfaction?______________________________________________________________________________________________________
  2. _______________________________________________________________________________

9.       How would you describe the management style within your department:

q        Consultative

q        Directive
q        Bureaucratic

q        Progressive/innovative
q        Inspirational/motivating
q        Approachable/supportive

q        Uninterested

q        Flexible
q        Inflexible

q        Technically competent

q        Other ____________________________________________________________________

Comments: _____________________________________________________________________


10.     If changes could be made to build on your manager’s effectiveness, what recommendations would you make?                                                                                                                   






11.     How often did you receive feedback from your manager?

q        Regular formal feedback
q        Regular informal feedback
q        Occasionally/adhoc feedback
q        Never received feedback

12.     What type of feedback was provided to you during your employment here?

q        Performance appraisals
q        Informal feedback
q        Verbal recognition and praise for your effort
q        Constructive criticism
q        Unfair/unreasonable criticism

q        None

13.     How would you describe the quality of the feedback you received?                                   



Training & Development


14.     How adequate was the training that was provided to you during your employment?

q        Sufficient job related training

q        Training offered – but not specific to needs

q        Insufficient job related training

Comments: _____________________________________________________________________


15.     Were there areas where you believe training needs in your job were not met? _______________


Career opportunities

16.     In your view, have there been adequate career opportunities available in the company?

q        Yes
q        No

q        Other____________________________________________________________________

17.     What type of career opportunities were important to you?

q        Promotional opportunities
q        Special project opportunities
q        Increased responsibility through additional tasks
q        Overseas opportunities
q        Position rotations/secondments
q        Not looking for any progression
q        Other____________________________________________________________________
Comments: _____________________________________________________________________



18.     How would you rate the effectiveness of company communication?

q        Effective
q        Average
q        Poor/ineffective

Comments: ____________________________________________________________________


19.     Within your department, how well informed are you in the following areas?

Uninformed                                 Informed

1        2        3        4        5

Organisation objectives, direction or strategy                 q      q      q      q      q

Purpose of the department or team                                       q      q      q      q      q

Own individual priorities                                             q      q      q      q      q

On-line/electronic developments                                  q      q      q      q      q

New product developments                                        q      q      q      q      q

Changes to internal systems                                       q      q      q      q      q

Customer requirements/needs                                     q      q      q      q      q

Other                                                                      q      q      q      q      q



20.     What recommendations would you make to improve overall communicaiton?                     




21.     How satisfied were you with the remuneration offered?

q      Satisfied – commensurate to the responsibility of the job
q      Reasonably satisfied – other things compensated
q      Dissatisfied – felt under valued

22.     Were there any other benefits you feel should have been considered? _____________________


Perception of the company


23.     How do you believe this company is perceived as a business? Please comment on the following           statements:
a) Our customers view our products and services as being high quality

q        Agree

q        Undecided
q        Disagree

b) The quality of our work is viewed by our customers as exceeding that of our competitors

q        Agree

q        Undecided
q        Disagree

c) We are perceived by the market as an innovative and progressive business
q        Agree
q        Undecided
q        Disagree
d) Our customers believe that we understand and respond to their needs

q        Agree

q        Undecided

q        Disagree

e) Employees are motivated and interested in providing excellent customer service

q        Agree

q        Undecided

q        Disagree

f) We are an employer that provides skill development, challenges and opportunities
q        Agree
q        Undecided
q        Disagree

24.     Would you recommend us as an employer?
q        Yes

q        No

q        Maybe







25.     Are there any other comments you would like to make (suggestions, concerns, opportunities           etc)?










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