SEPARATION INTERVIEW FORM

Name: _______________________ Date of joining: _______________________

Employee ID: _______________________ Date of Leaving: _______________________
Designation: _______________________ Manager’s Name: _______________________
Your feedback is critical and important to us and it helps track the good things and improvement
areas for the organization. Please feel free while you are marking your comments; your
credentials shall be kept confidential.

Please give us your perception of the organization on the following factors on a four point scale.
1- Never; 2 -Sometimes; 3 – Usually, 4-Mostly

Your Score
Parameters
1 2 3 4

I knew what was expected out of me at work

Role Clarity
My manager set clear & measurable goals for me & our team

We have clear processes and procedures for how we do our work

I was appreciated for my efforts

Recognition
Recognition Programs were consistent, fair and effective
Managers appropriately recognize employee contributions &
accomplishments
Performance The Performance Review is effective & is implemented consistently

& Feedback Manager provided periodic feedback on my performance &

behavior
Manager worked around a plan for me to work on my improvement
areas
Organization offers excellent career opportunities to those who
Rewards and
perform well
Compensatio Compensation offered to me was competitive with my peers
n I understood the pay & reward programs and they were effective

Learning & My seniors were concerned about my learning & development

Development The training provided to me was sufficient to perform my job well

My job was a good fit for my skills and interests

HR policies & processes are easy to understand and employee
People
friendly
Practices The HR team understand the HR processes well
The organization is concerned about the development of the
employees
Managers frequently communicate about organizational events &
Climate of
openness and happenings
There was fun at work
trust
I trust there will be action plan around the issues identified
through this feedback
This organization delivers on the promises it makes to its
Leadership of
Senior employees
The employees are treated as the most valued asset, atleast I felt
Management so
Senior Leaders filled me with excitement about the future of our
organization
 SEPARATION INTERVIEW FORM
What did you think of your supervisor on the following points?

Mostly Usually Sometimes

Never
Was consistently fair 4 3 2 1
Provided recognition 4 3 2 1
Resolved complaints 4 3 2 1
Was sensitive to employees' needs 4 3 2
1
Provided feedback on performance 4 3 2
1
Was receptive to open communication 4 3 2
1

How would you rate the following?

Excellent Good Fair
Poor
Cooperation within your division/program 4 3 2
1
Cooperation with other divisions 4 3 2
1
Personal job training 4 3 2 1
Equipment provided (materials, resources, facilities) 4 3 2
1
Company's performance review system 4 3 2
1
Company's new employee orientation program 4 3 2
1
Rate of pay for your job 4 3 2
1
Career development/Advancement opportunities 4 3 2
1
Physical working conditions 4 3 2
1

I will recommend the organization to friends as a good WORKPLACE 

Definitely May be
No
Kindly check on one of the following as your PRIMARY REASON for leaving the organization

o Senior management not Dynamic and o Job is a misfit with my skills

Enterprising
o Non-Cooperative Manager(s) o Stiff, unrealistic targets & performance
expectation
o Loose & Insensitive HR practices o Inadequate Compensation & Benefits

o Lack of Learning, Development & Growth o I was given a different impression about the
job profile before joining
o Inadequate Rewards & Recognition o Tremendous, undesirable work pressure

Two things which are, in your opinion, are ineffective and must be taken care of in priority
1. ___________________________________________________________________________________________________
2. ___________________________________________________________________________________________________

Your suggestions for improvement

Name:----------------------------------- Date:
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 SEPARATION INTERVIEW FORM

Comments HR Representative

Name:----------------------------------- Date:
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Exit form entry done by Name:----------------------------------- Date:

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