We would appreciate your candid answers to the following questions. Your individual responses are treated as confidential and will not become part of your personnel file. Results will be aggregated with responses from other employees before being disclosed to [Company Name] leadership.
We believe that your feedback is of vital importance and will assist [Company Name] in analyzing our employee retention and turnover. Thank you for your cooperation!
|
Name
|
Hire Date
|
|
Department
|
Separation Date
|
|
Position
|
Manager
|
What prompted you to seek alternative employment? (check all that apply)
☐ Type of work ☐ Compensation
☐ Lack of recognition ☐ Relationship with supervisor
☐ Working conditions ☐ Family circumstances
☐ Company culture ☐ Career advancement opportunity
☐ Business direction ☐ Other: ________________________
Please rate your supervisor below using a scale of 1-5, with 5 being strongly agree and 1 being strongly disagree. Please select one response for each statement.
| | | | | | | |
|---|---|---|---|---|---|---|
| Supervisor/Manager | 5 | 4 | 3 | 2 | 1 | N/A |
| Demonstrated fair and equal treatment | ° | ° | ° | ° | ° | ° |
| Provided recognition on the job | ° | ° | ° | ° | ° | ° |
| Developed cooperation and teamwork | ° | ° | ° | ° | ° | ° |
| Encouraged/listened to suggestions | ° | ° | ° | ° | ° | ° |
| Resolved complaints and problems | ° | ° | ° | ° | ° | ° |
| Followed policies and practices | ° | ° | ° | ° | ° | ° |
| Communicated well | ° | ° | ° | ° | ° | ° |
Comments or suggestions for improvement: | ||||||
Please rate your employment at [Company Name] below using a scale of 1-5, with 5 being highly satisfied and 1 being highly dissatisfied. Please select one response for each statement.
| | | | | | | |
|---|---|---|---|---|---|---|
| Employment Experience | 5 | 4 | 3 | 2 | 1 | N/A |
| Cooperation within your department | ° | ° | ° | ° | ° | ° |
| Cooperation with other departments | ° | ° | ° | ° | ° | ° |
| Communication with the company as a whole | ° | ° | ° | ° | ° | ° |
| Communication within your department | ° | ° | ° | ° | ° | ° |
| Training opportunities provided | ° | ° | ° | ° | ° | ° |
| Morale in your department | ° | ° | ° | ° | ° | ° |
| Advancement opportunities | ° | ° | ° | ° | ° | ° |
| Workload | ° | ° | ° | ° | ° | ° |
Comments or suggestions for improvement: | ||||||
Please rate the compensation and benefits at [Company Name] below using a scale of 1-5, with 5 being highly satisfied and 1 being highly dissatisfied. Please select one response for each statement.
| | | | | | | |
|---|---|---|---|---|---|---|
| Compensation and Benefits | 5 | 4 | 3 | 2 | 1 | N/A |
| Base salary | ° | ° | ° | ° | ° | ° |
| Incentive pay | ° | ° | ° | ° | ° | ° |
| Health insurance | ° | ° | ° | ° | ° | ° |
| Dental insurance | ° | ° | ° | ° | ° | ° |
| Vision insurance | ° | ° | ° | ° | ° | ° |
| Paid time off | ° | ° | ° | ° | ° | ° |
| 401(k) plan | ° | ° | ° | ° | ° | ° |
| Life insurance | ° | ° | ° | ° | ° | ° |
| Disability insurance | ° | ° | ° | ° | ° | ° |
| Other: _____________________ | ° | ° | ° | ° | ° | ° |
Comments or suggestions for improvement: | ||||||
What did you like most about your job and/or this company? _____________________________________________________________________
_____________________________________________________________________
What did you like least about your job and/or this company? _____________________________________________________________________
_____________________________________________________________________
Additional comments:
_____________________________________________________________________
_____________________________________________________________________
Would you recommend this company to a friend as a place to work?
☐ Yes, without reservations ☐ Yes, with reservations ☐ No
If no, why not? __________________________________________________________
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