Exit Interview Template for Exit Survey Questionnaire

Exit Interview Template (Long) helps you receive maximum insights through feedback from exiting employees. This sample survey questionnaire is fully customizable with complete brand personalization.
Need a shorter questionnaire? Check out Exit Interview Questions (Short Template)


 
 
How likely are you to recommend working with our organization to your friends or family members?
«Very UnlikelyVery Likely»
012345678910
 
 
What are your reasons for leaving [COMPANY_NAME]? (Check all that apply)
 
Higher Pay
 
Benefits
 
Better job opportunity
 
Commute
 
Conflict with other employees
 
Conflict with managers
 
Family and personal reasons
 
Relocation/Move
 
Career Change
 
Company Instability
 
Other
 

 
Please comment on job responsibilities on the following parameters based on your work experience with us:
1
Strongly Disagree
2
Disagree
3
Neutral
4
Agree
5
Strongly Agree
Job was challenging
Skills were effectively used
Job orientation was effective
Work load was reasonable
Sufficient resources were available
Work environment was safe, comfortable and appropriately equipped
 
Please comment on the Supervisor/Manager on the following parameters based on your work experience with us:
1
Strongly Disagree
2
Disagree
3
Neutral
4
Agree
5
Strongly Agree
Had knowledge of the job
Had knowledge of supervision
Was open to suggestions
Recognized employees contribution
 
Please comment on the department/team on the following parameters based on your work experience with us:
1
Strongly Disagree
2
Disagree
3
Neutral
4
Agree
5
Strongly Agree
Had good synergy
Had adequate equipment
Was adequately staffed
Was efficient
 
Please comment on the Senior Management on the following parameters based on your work experience with us:
1
Strongly Disagree
2
Disagree
3
Neutral
4
Agree
5
Strongly Agree
Gave fair and equal treatment
Was available to discuss job related issues
Welcomed suggestions and encouraged feedback
Maintained consistent policies and practices
Provided recognition for achievements
Encouraged cooperation/collegiality
Provided development opportunities
 
For the offered Compensation and Benefits, please rank the following parameters:
1
Very Dissatisfied 
2
Dissatisfied
3
Neutral
4
Satisfied
5
Very Satisfied
Medical insurance package
Dental coverage
Prescription drug coverage
Vision coverage
401(k) savings plan
Retirement program
Paid time off
Job market competitiveness of my salary
Stock option plan
Row 10
 
 
What did you like the most about working with our organization?
   
 
 
Did you get enough opportunities to explore your skills with our organization?
 
Yes, A lot
 
A Few
 
None at all
 
 
At the time of your onboarding, were your roles and responsibilities made clear to you?
 
Yes
 
Partially
 
No
 
 
How easy was it for you to maintain a work-life balance?
 
Very Easy
 
Easy
 
Neutral
 
Difficult
 
Very Difficult
 
 
Do you think your supervisor/manager gave you enough opportunities to use your skills and talents based on which you were hired?
 
Yes
 
Maybe
 
No
 
 
Given an opportunity, what could we change that would potentially convince you to stay back with us? Comments/Suggestions:
   
 
 
Do you have any other comments or suggestions?
   
 
 
Thank You for your input.



It is the [COMPANY_NAME] policy to consider employee survey responses as confidential and data will only be reported in aggregate form.

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