Employee Name
Department
Manager
Job Title
Location
Date or Month of Termination
Main reason for leaving?
Please indicate from the list below the main reason for leaving
Please select
Higher pay
Better benefits
Better career opportunity
Improved work life balance
Career change
Closer to home
Conflict with other employees
Conflict with managers
Family and/or personal reasons
Company instability
Other (type in reason below)
Other reason
Remuneration & Benefits
The salary was adequate in relation to responsibilities
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Wages were paid on time
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Other benefits were good
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Work-life balance was promoted and practiced
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
What improvements, other benefits could the company offer?
The Job itself
Job was challenging
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
There were sufficient opportunities for advancement
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Workload was manageable
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Sufficient resources and staff were available
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Your colleagues listened and appreciated your suggestions
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Your skills were effectively used
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
You had access to adequate training and development programs
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
What do you think can be improved about the job?
The Company
When you started, did the induction help and was it accurate
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Was a good and positive environment to work in
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Had adequate equipment to do the work
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Got on well with other staff within the company
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
There were sufficient staff to cover the work
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
The company was efficient in it’s dealings
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Internal communication worked well
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
There was no bullying or harassment
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
There are adequate parking facilities
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
The business did not discriminate against any employee
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
What do you think can be improved about the Department and Company?
Supervisor / Line Manager
Had sufficient knowledge of the job
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Is experienced in supervision
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Was open to suggestions
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Recognised and acknowledged achievements
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Acknowledged employees contributions
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Offered and promoted ways to develop
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Provided constructive feedback
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Clearly communicated management decisions and how they would effect your work
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Maintained a professional relationship with you
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
What are your suggestions or improvements to your Supervisor?
Management
Gave fair and equal treatment
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Was available to discuss job related issues
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Encouraged feedback and suggestions
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Maintained consistent policies and practices
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Provided recognition for achievements
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Gave opportunities to develop
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Provided constructive feedback
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
Clearly communicated decisions and how they would effect your work
Please select
Strongly Disagree
Disagree
Agree
Strongly Agree
What are your suggestions or improvements to Management?
Any any comments please let us know?
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