IOPEX EIF 004

Rev. No. 04
Date issued: June 01, 2014





DATE: _______________________



EXIT INTERVIEW FORM

Your departure from iOPEX Technologies Incorporated will indeed be a great loss to us.
However, we would like to take this opportunity to understand from you, the good practices we have and
also gaps in our existing systems and processes and try to further improve upon them.
Please feel free to expound on topics you prefer to answer or maintain silence on topics you want
to avoid. Your feedback is extremely important to us and we would be grateful for your honest comments
on the issues as mentioned hereunder. Rest assured that all details revealed here will be kept confidential
and will be used for attrition analysis purposes.

Employee Name: Date of Joining:
Program: Separation Date:
Position: Total Length of Service:
Interviewed by: Signature of Interviewer:

PART I: REASON FOR LEAVING
A. What made you decide to look for another position or leave the organisation?
(Please tick the top three reasons that have contributed to your decision to leave)

REASON TICK RATE (1-5) COMMENTS
Higher Salary
Career Progression
Better Job Satisfaction (Benefits)
Interest in new job
Relationship with management
Relationship with Colleagues
Change of career
Personal reasons
Changes in health
Health and Safety re: working environment
Hours of work
Location / travelling distance
Other: please give details


B. Did dissatisfaction with any of the following factors influence your decision to leave?

YES NO
Type of work
Working conditions (setting, schedule, travel, flexibility)
Pay
Supervisor / Upper Management
Location
Cost of living in area
Commute

COMMENTS:

IOPEX EIF 004
Rev. No. 04
Date issued: June 01, 2014


PART II: COMMENTS/SUGGESTIONS FOR IMPROVEMENT
(We are interested in what our employees have to say about their work experience with the Company. Please
complete this part)

1. What did you like most about your job?
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

2. What did you like least about your job?
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

3. Did you receive adequate training to do your job effectively?
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________

4. Please rate the following aspects of the job you are vacating. Use the scale below.

A. OVERALL Poor
Below
Average
Average
Above
Average
Excellent
Type of work performed
Fairness of workload
Salary
Working conditions
Tools and equipment provided
Training received
Co-workers
Supervision received
Level of input in decisions that affected you

B. JOB ITSELF
Strongly
Disagree
Disagree
Neither
Agree or
Disagree
Agree
Strongly
Agree
Job was challenging
There were sufficient opportunities for
advancement

Workload was manageable
Sufficient resources and staff were
available

Your colleagues listened and appreciated
your suggestions

Your skills were effectively used
You had access to adequate training and
development programs


C. REMUNERATION & BENEFITS
Strongly
Disagree
Disagree
Neither
Agree or
Disagree
Agree
Strongly
Agree
The salary was adequate in relation to
responsibilities

Wages were paid on time
Other benefits were good
Work-life balance was promoted and
practiced

The companys superannuation fund
returned good results



IOPEX EIF 004
Rev. No. 04
Date issued: June 01, 2014

Thank you for completing this information. Your responses will be treated with total confidentiality.


D. SUPERVISOR
NAME:
Strongly
Disagree
Disagree
Neither
Agree or
Disagree
Agree
Strongly
Agree
Had sufficient knowledge of the job
Is experienced in supervision
Was open to suggestions
Recognised and acknowledged achievements
Acknowledged employees contributions
Offered and promoted ways to develop
Provided constructive feedback
Clearly communicated management decisions
and how they would affect your work

Maintained a professional relationship with
you


What are your suggestions for improvement to your supervisor?



E. MANAGEMENT
Strongly
Disagree
Disagree
Neither
Agree or
Disagree
Agree
Strongly
Agree
Gave fair and equal treatment
Was available to discuss job related issues
Encouraged feedback and suggestions
Maintained consistent policies and practices
Provided recognition for achievements
Gave opportunities to develop
Provided constructive feedback
Clearly communicated decisions and how
they would affect your work


What are your suggestions for improvement to the management?



F. THE COMPANY
Strongly
Disagree
Disagree
Neither
Agree or
Disagree
Agree
Strongly
Agree
When you started, did the induction help and was
it accurate

Was a good and positive environment to work in
Had adequate equipment to do the work
Got on well with other staff within the company
There were sufficient staff to cover the work
The company was efficient in its dealings
Internal communication worked well
There was no bullying or harassment
The business did not discriminate against any
employee


What are your suggestions for improvement to the management?



5. Would you consider returning to employment within the Trust? Y / N