Exit Form
Employee Name
Employee Code
Designation
Joining Date
Reporting To
Date of Interview
Q 1: Why are you leaving the company?
Ans: _
Q 2: What suggestions for improvement do you have for us?
Ans
Q 3: If we implement those suggestions, would you return to work here?
YES NO
Q 4: Would you recommend this company to your friends as a good place to work?
YES NO
Strongly Somewhat Somewhat Strongly
For the following questions please choose:
agree agree disagree disagree
I believe that I was treated like a valuable
5
member of the company.
Please explain if you want to.
I received positive feedback from my immediate
6
supervisor when I was doing a good job.
Please explain if you want to.
I felt free to suggest to my supervisor changes that
7
would improve my project / department.
Please explain if you want to.
My job duties and responsibilities were clearly
8
defined.
Please explain if you want to.
I received the proper training in order to perform
9
my job effectively.
Please explain if you want to.
Employee problems and complains were solved
10
fairly and promptly in my department
Please explain if you want to.
11 If I have questions or concerns, I felt comfortable speaking with:
My immediate supervisor
Senior management
Human resources
Please explain if you want to.
I was kept well informed about company's policies
12
and procedures or other important information.
Please explain if you want to.
I felt that the company provided me with a good
13
work environment
Please explain if you want to.
14 Please list any additional benefits that you have wanted the company to offer
15 Additional comments and suggestions: