Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Personal information

  • Name

  • Job title / position

  • Area of the organisation that you worked in.

  • Add location
  • Sex

  • Ethnic origin

  • Nationality - please state

  • Religion - please state

  • Sexual orientation

  • Do you have a disability?

  • Age

  • Approximate length of service

  • Type of contract

Reason for leaving

  • Please rank as appropriate your reason for leaving (up to a maximum of 3) with 1 being the primary reason for leaving

  • Unhappy with management style/ personality conflict

  • Family reasons

  • End of contract

  • Relocation

  • Ill-health

  • Career progression

  • Specific problem with one member of the organisation

  • Please provide the name of the specific individual and your problem with that individual

  • Company culture and work ethos

  • Training and development opportunities

  • Working hours - too long

  • Working hours - not enough

  • Working hours - too inflexible

  • Salary -too low

  • Better salary offer

  • Returning to education

  • Working conditions poor

  • Redundancy

  • Better prospects in new role

  • Other reason - please specify

Career progression within company

  • We're you satisfied with the recruitment and selection process when recruited to your current position?

  • Did you receive adequate induction training into the company

  • Did you receive an accurate job description for your current role?

  • Did you receive adequate company information such as handbook when you joined the business?

  • Did you receive adequate training and development in order to carry out your role effectively?

  • Did you receive a regular performance review during your time in the company?

  • Did you feel satisfied with the benefits provided by the company?

Relationships within the company

  • How would you rate your relationship with your colleagues on a scale of 1-10 with 10 being fantastic!

  • How would you rate your relationship with your direct line manager on scale of 1-10?

  • How would you rate your relationship with company senior management on a scale of 1-10?

  • How do you rate the support provided by the company on a scale of 1-10

The company as a place to work

  • How would you rate the company as an employer compared to other organisations of a similar style you either know of or have heard about?

  • Can you expand on your answer

  • How do you rate the communication within the organisation?

  • Can you expand on your answer

  • Please describe how the company listens and responds to its workforce?

  • How do you feel the company rates in the application of policy and procedures?

  • Can you expand on your answer?

  • Where you satisfied with the companies provision of health and safety issues?

Specifically about your time and experience in working for the company.

  • For how long have you wanted to leave the company?

  • Has your time with the company been an enjoyable experience?

  • If a friend asked you, would you recommend that they take a job here?

  • What were your best experiences here?

  • What were your worst experiences here?

  • What message would you give to management on your departure?

  • If you could change anything about how the company operates, what would it be?

  • If you had the chance to do it all over again - would you?

  • How is your new job different from this one / what do you hope will be different?

Final comments

  • Please use this space to share any information which you feel needs to be communicated?

  • Add signature

  • Thank you for sharing this information, the company would like to take this opportunity to wish you all the very best in your future career.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.