Exit Interview Questionaire

Corporate Exit Interview Questionnaire
Your experiences can help us continue to improve programming for clients and other staff.
Honest feedback is always appreciated! This form goes directly to the corporate office, not your coordinator.
Thank you for being a member of our team!

* Indicates required field

Name *

First

Last

Today's Date *

Last Date Worked *

Length of Employment: Years/Months *

Manager *

Program *

Residential Vocational Senior Day Program

Reason for Leaving:

Comment *

If there was an issue that lead to your decision to leave, did you tell your supervisor? *

Yes No Not Applicable

If checked yes above, did they attempt to correct the issue? *

Yes No

If no, please explain: *

1. How would you rate CHS's work environment? *

2. How well were you trained for the job/tasks of the job? *

3. How would you rate the management’s communication? *

4. How well were your concerns/ questions addressed? *

5. Rate the quality of care provided to consumers. *

6. Did you understand CHS’s policies and procedures? *

7. How consistently were policies and procedures followed/ enforced? *

8. How would you rate the wage/ benefits? *

If you rated a 1 or 2 for the above questions, please explain why:

Comment *

Any additional comments:

Comment *

Submit