Hi Ravindra,
This could also be helpful..this is not my work but has been posted on this...ETERNAL HR FORUM.
EXIT INTERVIEW QUESTIONNAIRE
This questionnaire and your scheduled exit interview are important elements of our separation policy. Your assistance in this matter will be greatly appreciated. As an opportunity to make a final contribution toward improving areas of concern, your assistance is greatly appreciated. Please be open and honest in order that we may better serve our associates in the future.
Name: Date of Hire:
Department: Date of Separation:
Job Title: Supervisor:
1) What is (are) the primary reason(s) for leaving the Company?
1)
2)
3)
Comments
2) How long have you been considering your decision to leave the company
3) Please tell us the specific incident/event which has triggered your thought process of leaving the company.
1. 2.
4) Have you ever discussed your dissatisfaction/grievance with anyone? If Yes, with whom and when? Was there any attempt to mitigate your concern?
5) What could have been done to retain you as an associate
1.
2.
7) How did each of the following influence your decision? Please respond by circling one number below for each item.
Factors Affecting Separation Decisive Very Important Important Not so important
A. Nature of Work
B. Salary & Benefits
C. Lack of Career growth opportunity
D. Immediate Superior**
E. Organization Culture (Speed of decision making, ethical work behavior, open communication etc.)
F. Hygiene Factor (Designation, Commuting Distance, work hours etc.)
G. Unfriendly work environment
H. Lack of Self Development opportunity
I. Lack of professionalism
J. Insufficient training to perform the job effectively
K. Not so clear understanding about roles and responsibilities
L. Insufficient & Infrequent feedback on work performance
** Please give a few specific examples to illustrate why you are leaving because of your immediate superior.
8) What are the attributes, in your new assignment , you find more appealing compared to your current job?(In case of multiple reasons, would you mind giving priorities)
- Role/Job Nature
- Wage(by what percentage)
- Growth Opportunities :
- Designation:
- Location
- Any Other
9) What changes would you suggest for Company in India to make it a better place to work for?
1. 2.
Exit Interviewer's Signature: _____________________________ Date:_________________
Associates Signature: ___________________________________
Date: