EXIT INTERVIEW QUESTIONNAIRE
Confidential Feedback Survey for Departing Employees
Employee Name: [EMPLOYEE FULL NAME]
Position/Title: [JOB TITLE]
Department: [DEPARTMENT NAME]
Hire Date: [START DATE]
Last Day of Work: [END DATE]
Interview Date: [INTERVIEW DATE]
Interviewer: [HR REP NAME]
Length of Service: [YEARS/MONTHS]
📋 Purpose of This Interview:
Your honest feedback is valuable and will help us improve our workplace. All responses are confidential and will only be shared in aggregate form. This interview is voluntary, and your participation is appreciated.
1. REASON FOR LEAVING
Q1: What is your primary reason for leaving?
☐ New job opportunity / Career advancement
☐ Better compensation / Benefits
☐ Relocation / Personal reasons
☐ Work-life balance concerns
☐ Lack of growth opportunities
☐ Management or leadership issues
☐ Company culture / Work environment
☐ Job responsibilities not aligned with expectations
☐ Returning to school
☐ Retirement
☐ Other: [SPECIFY]
Q2: Please elaborate on your reason for leaving:
Q3: Was there a specific event or situation that prompted your decision?
Q4: Did you discuss your concerns with anyone before deciding to leave?
☐ Yes - Manager
☐ Yes - HR
☐ Yes - Colleague
☐ No
Comments:
2. JOB SATISFACTION
Rating Scale:
| Aspect | Rating | Comments |
|---|---|---|
| Overall job satisfaction | [1-5] | [COMMENTS] |
| Clarity of job responsibilities | [1-5] | [COMMENTS] |
| Workload and work-life balance | [1-5] | [COMMENTS] |
| Tools and resources provided | [1-5] | [COMMENTS] |
| Professional development opportunities | [1-5] | [COMMENTS] |
| Recognition and appreciation | [1-5] | [COMMENTS] |
3. MANAGEMENT & LEADERSHIP
| Aspect | Rating | Comments |
|---|---|---|
| Relationship with direct manager | [1-5] | [COMMENTS] |
| Manager's communication and feedback | [1-5] | [COMMENTS] |
| Manager's support and mentorship | [1-5] | [COMMENTS] |
| Senior leadership visibility and direction | [1-5] | [COMMENTS] |
Q5: What could your manager have done differently to improve your experience?
4. TEAM & WORK ENVIRONMENT
| Aspect | Rating | Comments |
|---|---|---|
| Team collaboration and dynamics | [1-5] | [COMMENTS] |
| Company culture and values | [1-5] | [COMMENTS] |
| Diversity and inclusion | [1-5] | [COMMENTS] |
| Physical work environment | [1-5] | [COMMENTS] |
Q6: Did you feel valued and respected as a team member?
☐ Yes, always
☐ Most of the time
☐ Sometimes
☐ Rarely
☐ Never
5. COMPENSATION & BENEFITS
| Aspect | Rating | Comments |
|---|---|---|
| Salary competitiveness | [1-5] | [COMMENTS] |
| Benefits package (health, dental, etc.) | [1-5] | [COMMENTS] |
| PTO and leave policies | [1-5] | [COMMENTS] |
| Bonus and incentive programs | [1-5] | [COMMENTS] |
Q7: Did compensation play a role in your decision to leave?
☐ Major factor
☐ Minor factor
☐ Not a factor
6. PROFESSIONAL DEVELOPMENT
Q8: Did you feel you had opportunities for career growth and advancement?
☐ Yes, significant opportunities
☐ Some opportunities
☐ Limited opportunities
☐ No opportunities
Q9: Were you provided with adequate training and development resources?
☐ Yes, more than adequate
☐ Yes, adequate
☐ Somewhat adequate
☐ Not adequate
Q10: Were your career goals discussed and supported by your manager?
7. COMPANY POLICIES & PROCEDURES
Q11: Were company policies clearly communicated and fairly applied?
☐ Yes, always
☐ Most of the time
☐ Sometimes
☐ Rarely
☐ Never
Q12: Did you feel comfortable raising concerns or providing feedback?
8. RECOMMENDATIONS & SUGGESTIONS
Q13: What did the company do well that should be continued?
Q14: What are the top 3 things the company could improve?
- [IMPROVEMENT 1]
- [IMPROVEMENT 2]
- [IMPROVEMENT 3]
Q15: What would have made you stay?
Q16: What advice would you give to someone starting in your role?
9. FUTURE RELATIONSHIP
Q17: Would you recommend this company as a place to work?
☐ Definitely yes
☐ Probably yes
☐ Not sure
☐ Probably not
☐ Definitely not
Q18: Would you consider returning to the company in the future?
☐ Yes
☐ Maybe
☐ No
Q19: May we contact you for alumni engagement or networking opportunities?
☐ Yes
☐ No
Preferred contact: [EMAIL/PHONE/LINKEDIN]
10. ADDITIONAL COMMENTS
Q20: Is there anything else you would like to share?
11. NEW EMPLOYMENT (Optional)
New Employer: [COMPANY NAME OR DECLINE TO ANSWER]
New Position: [TITLE OR DECLINE TO ANSWER]
Primary factors that attracted you to new role:
[FACTORS OR DECLINE TO ANSWER]
ACKNOWLEDGMENT
Confidentiality Notice: This exit interview is confidential. Responses will be used to improve our workplace and will only be shared in aggregate form to protect your privacy.
By signing below, I acknowledge that I have completed this exit interview voluntarily and honestly.
EMPLOYEE:
Signature: [SIGNATURE]
Printed Name: [FULL NAME]
Date: [DATE]
HR REPRESENTATIVE:
Signature: [SIGNATURE]
Printed Name: [FULL NAME]
Date: [DATE]
FOR HR USE ONLY
Key Themes Identified:
[HR SUMMARY OF KEY FINDINGS]
Action Items:
[RECOMMENDED ACTIONS BASED ON FEEDBACK]
Eligible for Rehire:
☐ Yes
☐ No
☐ Maybe (explain): [EXPLANATION]
