Exit Interview Form

Name: Hire Date: Resignation Date: Last Day at Company: Department: Manager:

1. Briefly indicate what factors first caused you to consider lea ing the company:

!. Briefly indicate what factors triggered your lea ing the company at this time:

". #hat is your o erall opinion of the company$ %lease rate the following using this scale: 1 & e'cellent ! & good " & fair ( & poor

)***+ Benefits )***+ %ay )***+ Recruiting %rocess )***+ ,rientation %rocess )***+ -nitial .raining )***+ -nterest in /mployees )***+ 0rowth ,pportunities )***+ ,ngoing .raining

)***+ %hysical #or1ing Conditions )***+ 2eeping /mployees -nformed )***+ .reating /mployees 3airly )***+ 4pholding Company 5alues )***+ Morale , erall )***+ ,pen&Door %olicy )***+ Morale in 6our 7rea )***+ %erformance Re iew %rocess )***+ Helpfulness82nowledge of Human Resources )***+ Medical8Health Benefits )***+ ,ther Benefits )***+ Cooperation among 7ll /mployees and Management )***+ /9uipment8Resources to Do :o; %roperly )***+ Recognition for :o; #ell Done )***+ -ncenti e8Bonus %rogram )***+ Communication of -nternal ,pportunities )***+ Company<s Concern with =uality and /'cellence )***+ , erall Company -mage

(. %lease comment on any 1 or ! scores in the space ;elow:

>. %lease rate your manager using this scale: 1 & always ! & usually " & seldom ( & ne er

)***+ Resol ed complaints and concerns promptly. )***+ Listened to suggestions. )***+ /ncouraged cooperation. )***+ .reated you fairly. )***+ %ro ided leadership. )***+ Clearly communicated e'pectations. )***+ #as honest. )***+ 0a e performance feed;ac1. )***+ Coached? trained? and de eloped you. )***+ Recogni@ed accomplishments. )***+ %ro ided appropriate and challenging assignments. )***+ Built teamwor1.

A. %lease comment on any 1 or ! scores in the space ;elow:

B. Do you ha e another Co;$ -f so? how does it compare with your last Co; here$

D. #hat did you li1e most a;out your last Co;$

E. #hat did you li1e least a;out your last Co;$

1F. #hat could ha e ;een done to encourage you not to lea e$

11. #as this made 1nown to your manager$

1!. #hy did you originally Coin the company$

1". #hat did you li1e most a;out the company$

1(. #hat did you li1e least a;out the company$

1>. #ere there any company policies or procedures that made your wor1 more difficult$

1A. #ould you ;e open to the idea of returning to our company$

1B. #hy8#hy not$

1D. #ould you recommend this company to a friend as a good place to wor1$

1E. Do you ha e any o;Cection to our sharing your responses with management$

!F. Do you thin1 the company li es up to its alues$ **6es **No

!1. -f no? which alues did we not li e up to? and how can we change for the ;etter$

!!. #hat other suggestions do you ha e that will help the company impro e$

!". #hat suggestions do you ha e that will help the company 1eep good people$

!(. 7ny other comments you would li1e to add at this time:

Employees Signature Interviewers Signature

Date Date