Exit Interview example

This is an example Exit Interview survey. This survey includes questions like:

We hope this will help you create your own Exit Interview survey. We have not tested the validitiy or reliability of this survey. However, you may use this as a starting point to help your own survey instrument. Feel free to change and edit any of our survey templates to help you get started.

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1) What was your main reason for leaving the company?

Please tell us how satisfied or dissatisfied you were with each of the following:

2) How satisfied were you with the quality of your work environment?
  • Very Dissatisfied
  • Dissatisfied
  • Satisfied
  • Very Satisfied
3) How satisfied were you with the company provided benefits?
  • Very Dissatisfied
  • Dissatisfied
  • Satisfied
  • Very Satisfied
4) How satisfied were you with your potential for advancement?
  • Very Dissatisfied
  • Dissatisfied
  • Satisfied
  • Very Satisfied

Please tell us how much you agree or disagree with each of the following statements:

5) My immediate supervisor was respectful and fair.
  • Strongly Disagree
  • Disagree
  • Agree
  • Strongly Agree
6) My immediate supervisor was knowledgeable about my job.
  • Strongly Disagree
  • Disagree
  • Agree
  • Strongly Agree
7) I was given adequate time to complete my job responsibilities.
  • Strongly Disagree
  • Disagree
  • Agree
  • Strongly Agree
8) I was given adequate physical space needed to perform my job responsibilities.
  • Strongly Disagree
  • Disagree
  • Undecided
  • Agree
  • Strongly Agree
9) My workload was:
  • Too Much
  • Just About Right
  • Too Little
10) Overall, how satisfied were you working for the company?
  • Very Dissatisfied
  • Dissatisfied
  • Satisfied
  • Very Satisfied
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