Employee Name: ____________________________________
Position: ____________________________________
Department: ____________________________________
Start Date: _______________
End Date: _______________
Interview Date: _______________
Interviewer: ____________________________________
What influenced your decision to leave?
Was this decision based on a specific event or over time?
☐ Specific event
☐ Over time
Primary reason for leaving:
☐ Career growth
☐ Compensation
☐ Management
☐ Work environment
☐ Workload
☐ Other: __________________________
Did your role meet your expectations?
☐ Yes ☐ No ☐ Partially
Comments:
What did you enjoy most about your role?
What challenges did you experience?
How would you rate your experience with your direct manager?
1 ☐ 2 ☐ 3 ☐ 4 ☐ 5 ☐
Did you feel supported in your role?
☐ Yes ☐ No ☐ Sometimes
Comments:
What could management have done differently?
How would you describe the work environment?
Did you feel comfortable raising concerns?
☐ Yes ☐ No
Did you feel respected and valued?
☐ Yes ☐ No ☐ Sometimes
Any concerns with team dynamics or communication?
How would you describe communication between departments?
Did you feel supported by other teams when needed?
☐ Yes ☐ No ☐ Sometimes
Comments:
Did you receive adequate training for your role?
☐ Yes ☐ No
Were there opportunities for growth?
☐ Yes ☐ No
What additional support would have helped?
Were you satisfied with your compensation?
☐ Yes ☐ No ☐ Somewhat
Comments:
Is there anything that could have been done to keep you here?
Would you recommend this company as a place to work?
☐ Yes ☐ No ☐ Maybe
Would you consider returning in the future?
☐ Yes ☐ No ☐ Maybe
Any additional comments or feedback?
Key Themes Identified:
Concerns/Risks:
Recommended Actions: