Exit Questionnaire

This form should be completed by the employee and provided to the Line Manager prior to the exit interview.

The purpose of the exit questionnaire and interview is to enable the Council to examine the reasons why people leave the organisation and to identify any improvements in employment practice that could be made.  Details supplied will be recorded on a database and used to produce regular monitoring information to help the Council develop its employment practices.  No individual will be identified in the reporting of information for monitoring purposes.  
Details provided on the questionnaire and comments made during the interview will not influence future references or re-employment with the Council.  

If you have any queries regarding this form or the exit interview process, please contact your Area Personnel Adviser

Employee Name:	     	Payroll Number:	     	
				
Sex:		Male 
	Female 	Length of Service:	      years
      months	
				
Line Manager’s Name:	     	Leaving Date:	     	
				
Service:	     
	Location:	     	
				
Contract Type:		Permanent
	Fixed-term
	Variable
	Casual	Work Pattern:		Full-time
	Part-time
	Flexible

1. Method of Leaving

•	Please Tick
		Retirement
	Ill-health Retirement
	Redundancy
	Dismissal
	Resignation 
	End of Temporary Contract
	Early Retirement/Voluntary Severance	Where the method of leaving is resignation please complete Section 2	
				
2. Reasons for Resignation 
Please record your main reason(s) for resignation in order of importance from 1 – 4 where 1 is the most important.  If your answer includes ‘other reasons’ please state these (if appropriate) in the space allowed.	
Personal Reasons

	 	Health
 	Home relocation
 	Caring responsibilities
 	Not returning to work following maternity leave
 	Need for change
 	Travel problems/work closer to home
 	Other personal reason

Please state other reason:
     	Reasons relating to career progression

	 	Promotion/higher paid job
 	Lack of training/career development opportunities
 	Taking up full/part-time education/study
 	Any other reason relating to career progression

Please state other reason:
     
	
Reasons relating to the job

	 	Lack of job security 
 	Dissatisfaction with workload
 	Dissatisfaction with duties
 	Dissatisfaction with working environment
 	Any other reason relating to job

Please state other reason:
     	Reasons relating to the workplace

	 	Problems with work colleagues
 	Problems with Manager
 	Discrimination
 	Harassment and/or bullying
 	Any other reason relating to the workplace

Please state other reason:
     	

Thank you for your co-operation
Return
Please provide a copy of this form to your Line Manager prior to the exit interview.