Exit Interview Questionnaire

We would appreciate you taking about 8 -10 minutes to answer the following questions as honestly as possible. Your individual responses are treated as confidential, and will not become part of your personnel file.

We believe that the information is of vital importance and will assist in analyzing our employee retention and turnover. Thank you for your cooperation!

Question Title

* 1. Demographics

Name (Optional)

Department

Position

Employment Start Date

Employment Termination Date

Manager

Question Title

* 2. What prompted you to seek alternative employment?

Type of Work

Compensation

Lack of Recognition

Company Culture

Business Direction

Quality of Supervision

Work Conditions

Family Circumstances

Career Advancement Opportunity

Other (please specify)

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* 3. Before making your decision to leave, did you investigate other options that would enable you to stay?

Yes

If "Yes" describe:

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* 4. What did you think of your supervisor(s) in regard to the following?

	Almost always	Sometimes	Never	N/A
Demonstrated fair and equal treatment	Demonstrated fair and equal treatment Almost always	Demonstrated fair and equal treatment Sometimes	Demonstrated fair and equal treatment Never	Demonstrated fair and equal treatment N/A
Provided recognition on the Job	Provided recognition on the Job Almost always	Provided recognition on the Job Sometimes	Provided recognition on the Job Never	Provided recognition on the Job N/A
Developed cooperation and teamwork	Developed cooperation and teamwork Almost always	Developed cooperation and teamwork Sometimes	Developed cooperation and teamwork Never	Developed cooperation and teamwork N/A
Encouraged/listened to suggestions	Encouraged/listened to suggestions Almost always	Encouraged/listened to suggestions Sometimes	Encouraged/listened to suggestions Never	Encouraged/listened to suggestions N/A
Resolved complaints and problems	Resolved complaints and problems Almost always	Resolved complaints and problems Sometimes	Resolved complaints and problems Never	Resolved complaints and problems N/A
Followed policies and procedures/practices	Followed policies and procedures/practices Almost always	Followed policies and procedures/practices Sometimes	Followed policies and procedures/practices Never	Followed policies and procedures/practices N/A

Comments

Question Title

* 5. How would you rate the following in relation to your job?

	Excellent	Good	Fair	Poor	N/A
Cooperation within your department	Cooperation within your department Excellent	Cooperation within your department Good	Cooperation within your department Fair	Cooperation within your department Poor	Cooperation within your department N/A
Cooperation with other departments	Cooperation with other departments Excellent	Cooperation with other departments Good	Cooperation with other departments Fair	Cooperation with other departments Poor	Cooperation with other departments N/A
Communication in your department	Communication in your department Excellent	Communication in your department Good	Communication in your department Fair	Communication in your department Poor	Communication in your department N/A
Communications within the Agency as a whole	Communications within the Agency as a whole Excellent	Communications within the Agency as a whole Good	Communications within the Agency as a whole Fair	Communications within the Agency as a whole Poor	Communications within the Agency as a whole N/A
Communications between you and your manager	Communications between you and your manager Excellent	Communications between you and your manager Good	Communications between you and your manager Fair	Communications between you and your manager Poor	Communications between you and your manager N/A
Morale in your department	Morale in your department Excellent	Morale in your department Good	Morale in your department Fair	Morale in your department Poor	Morale in your department N/A
Job Satisfaction	Job Satisfaction Excellent	Job Satisfaction Good	Job Satisfaction Fair	Job Satisfaction Poor	Job Satisfaction N/A
Training you received	Training you received Excellent	Training you received Good	Training you received Fair	Training you received Poor	Training you received N/A
Growth Potential	Growth Potential Excellent	Growth Potential Good	Growth Potential Fair	Growth Potential Poor	Growth Potential N/A

Comments

Question Title

* 6. Was your workload usually:

Too great

Varied, but all right

About right

Too light

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* 7. How did you feel about your salary and the employee benefits?

	Excellent	Good	Fair	Poor
Base Salary	Base Salary Excellent	Base Salary Good	Base Salary Fair	Base Salary Poor
Medical Plan	Medical Plan Excellent	Medical Plan Good	Medical Plan Fair	Medical Plan Poor
Dental Plan	Dental Plan Excellent	Dental Plan Good	Dental Plan Fair	Dental Plan Poor
Vision Plan	Vision Plan Excellent	Vision Plan Good	Vision Plan Fair	Vision Plan Poor
Retirement 403(b), 401(a) Plans	Retirement 403(b), 401(a) Plans Excellent	Retirement 403(b), 401(a) Plans Good	Retirement 403(b), 401(a) Plans Fair	Retirement 403(b), 401(a) Plans Poor
Life Insurance	Life Insurance Excellent	Life Insurance Good	Life Insurance Fair	Life Insurance Poor
Air Evac Emergency Response Membership	Air Evac Emergency Response Membership Excellent	Air Evac Emergency Response Membership Good	Air Evac Emergency Response Membership Fair	Air Evac Emergency Response Membership Poor
Vacation time off	Vacation time off Excellent	Vacation time off Good	Vacation time off Fair	Vacation time off Poor
Sick time off	Sick time off Excellent	Sick time off Good	Sick time off Fair	Sick time off Poor
Holiday	Holiday Excellent	Holiday Good	Holiday Fair	Holiday Poor

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* 8. Are there any other benefits you feel should have been offered?

Yes

If "Yes" what?

Exit Interview Questionnaire

Question Title

* 1. Demographics

Question Title

* 2. What prompted you to seek alternative employment?

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* 3. Before making your decision to leave, did you investigate other options that would enable you to stay?

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* 4. What did you think of your supervisor(s) in regard to the following?

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* 5. How would you rate the following in relation to your job?

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* 6. Was your workload usually:

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* 7. How did you feel about your salary and the employee benefits?

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* 8. Are there any other benefits you feel should have been offered?

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* 9. Any other comment or benefits?

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* 10. How frequently did you get performance feedback?

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* 11. What were your feelings about the performance review process?

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* 12. How frequently did you have discussions with your manager about your career goals?

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* 13. What did you like most about your job and/or SCHRA?

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* 14. What did you like least about your job and/or SCHRA?

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* 15. What does your new job offer that your job with this Agency does not?

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* 16. Why is the new job/company better?

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* 17. Do you have any suggestions for improvement? Have you raised them in the past?

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* 18. Would you recommend SCHRA to a friend as a place to work?

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* 19. Additional comments about your job or SCHRA