Exit interview form template
An exit interview form with the reason for leaving, 1 to 5 ratings on management, pay and work environment, open questions and a would-you-return line.
- 🇺🇸 US format · Letter size
- Free
This is a sample form. Check that the terms and pay match federal and state labor rules and your company policy.
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Listen, do not argue
An exit interview is for collecting what the person is willing to share. Thank them, take notes, and do not defend decisions or managers in the meeting. Sort the answers across several interviews before acting on any one of them.
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Exit Interview Form
Northwind Traders
| Employee | Jordan Lee | Department | Marketing |
|---|---|---|---|
| Last day | October 30, 2026 | ||
| Interviewer | Riley Chen, Human Resources | ||
Thank you for your time at Northwind Traders. Your answers help us make the workplace better for the people who stay, and they are used only for that purpose.
1. Reason for leaving (check all that apply)
□ New job □ Pay □ Management □ Growth
□ Relocation □ Personal □ Retirement □ Other If other: ____________________________
2. Your experience
| Statement | 1 = strongly disagree, 5 = strongly agree |
|---|---|
| 1. My manager supported me and gave useful feedback. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 2. My pay and benefits were fair for the work I did. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 3. My workload was manageable. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 4. I received the training I needed to do my job well. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 5. I was kept informed about decisions that affected my work. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 6. I had opportunities to learn and advance. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 7. My work was recognized. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 8. The work environment was respectful and safe. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 9. I had the tools and equipment I needed. | □ 1 □ 2 □ 3 □ 4 □ 5 |
| 10. I would recommend this company as a place to work. | □ 1 □ 2 □ 3 □ 4 □ 5 |
3. In your own words
1. What is the main reason you decided to leave?
____________________________________________________________
____________________________________________________________
2. What did you like most about working here?
____________________________________________________________
____________________________________________________________
3. What would you change if you could change one thing?
____________________________________________________________
____________________________________________________________
4. Was there anything that would have changed your decision to leave?
____________________________________________________________
____________________________________________________________
4. Looking ahead
Would you consider returning to Northwind Traders in the future? □ Yes □ No □ Maybe
May we contact you with follow-up questions? □ Yes □ No
Employee signature (optional): Jordan Lee
Interviewer: Riley Chen, Human Resources
Date: ____________
How to use it
Type the company and, unless the form is anonymous, the employee's name, department and last day. The form prints reason-for-leaving check boxes, ten statements with a 1 to 5 check line each, four open questions with lines to write on and a would-you-return question. Replace the statements or questions with your own, one per line, if your company tracks specific topics.
Give the form to the employee a few days before the last day so they can fill it in alone, or use it as the interviewer's script in a 30-minute meeting. File it with HR, not with the manager, and compare answers across departures each quarter.
Things to watch
Answers are more candid when the form is anonymous or when HR, not the direct manager, runs the interview. Keep the ratings on the same 1 to 5 scale from one departure to the next so the numbers can be compared. Do not use the meeting to talk the person out of leaving.
Calculators that go with this
Frequently asked questions
Should the employee's manager be in the room?
Usually not. People say less about their manager with the manager present. HR or a manager from another team gets more useful answers.
Can the employee refuse the interview?
Yes. Exit interviews are voluntary in practice. Offer the printed form to fill in at home as an alternative.
How do I use the ratings?
Average each statement across several departures. One low rating is a data point; the same statement low across five exits is a pattern worth a conversation with the leadership team.
Is what I type saved anywhere?
No. Everything stays in your browser and nothing is sent to our server. If you refresh the page it is gone, so print, save a PDF or download the DOCX when you are done.