Free form template · Word

Exit Interview Feedback Form

An exit interview feedback form is a short self-filled form the departing employee completes, usually in ten minutes, before or after the exit conversation. It uses tick-box ratings and a few comment lines, which makes it ideal for high-volume exits such as frontline, retail or plant roles.

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[Company Logo][Company Name]

EXIT FEEDBACK FORM

Department:: [Department]
Date:: [Date]

Dear colleague, thank you for your time with [Company Name]. Please spend ten minutes on this form. Your feedback is confidential and will not affect your settlement or relieving documents.

Name (optional)
Designation
Length of Service
Shift / Location

1. Main reasons for leaving (tick up to three)

Salary
Better job elsewhere
Supervisor / manager
Working hours or shifts
Travel distance
Workload
Lack of growth
Family or personal reasons
Health
Other: ____________

2. Please tick one option for each statement

Statement	Agree	Neutral	Disagree
I was paid correctly and on time
My supervisor treated me with respect
I received enough training for my work
The workplace was safe
I could raise problems without fear
I would recommend this company to friends

3. Comments

One thing we should improve
One thing you liked about working here
Would you like to rejoin in future? (Yes / No)
May HR contact you about this feedback? (Yes / No) – if yes, phone or email

Declaration: I have filled this form voluntarily and my feedback reflects my own experience.

Employee (optional)
[Employee Name]
Date: [Date]

Received by HR
[HR Name]
Date: [Date]

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What this template includes

Minimal identifying details
Tick-box top reasons for leaving
Agree / disagree statements on key areas
Short comment boxes
Consent to be contacted for follow-up
Confidentiality assurance

When to use it

You have many exits each month and cannot interview everyone
Frontline, retail or factory staff need a simple paper form
You want the employee's own written feedback in addition to the interviewer's notes
The leaver prefers not to have a face-to-face conversation

How to customise this template

1Keep it to one page so it gets completed
2Translate into Hindi or the regional language for shop-floor staff
3Match the statements to the drivers you track in engagement surveys
4Collect it in a sealed box or online form for privacy

HR tips

Hand it over at the start of the last day, not at the gate
Explain that feedback will not affect settlement
Review forms monthly and look for patterns by department or shift
Close the loop by sharing actions taken with current employees

For HR & hiring managers

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Frequently asked questions

How is an exit feedback form different from an exit interview?+

The feedback form is filled by the employee on their own in a few minutes. An exit interview is a conversation led by HR, which allows deeper follow-up questions.

Can exit feedback forms be anonymous?+

They can be made anonymous if you remove the name field and collect forms in a box or anonymous online link, though you lose the ability to follow up.

What should HR do with exit feedback?+

Summarise it monthly or quarterly by reason and department, share trends with leadership and agree actions on the top issues.

All 50 resignation, exit & full-and-final settlement →

[Company Logo][Company Name]
EXIT INTERVIEW FORM
Interview Date:
[Date]
Mode:
[In person / Video / Phone]
Interviewer:
[HR Name]
Employee Details
Employee Name
Employee ID
Designation
Department
Reporting Manager
Date of Joining
Last Working Day
Total Service (years / months)
Reasons for Leaving
Primary reason
Secondary reasons
When did you first think of leaving?
Was there anything that could have changed your decision?
Ratings (1 = Very poor, 5 = Excellent)
Form · Word
Employee Exit Interview Form
Download .docx

Primary reason
Secondary reasons
When did you first think of leaving?
Was there anything that could have changed your decision?

[Company Logo][Company Name]

EXIT CLEARANCE FORM

Form No.:: [Reference Number]
Date Issued:: [Date]

Part A: Employee Details

Employee Name
Employee ID
Designation
Department
Work Location
Date of Joining
Date of Resignation / Separation
Last Working Day
Type of Separation (Resignation / Retirement / Termination / Contract End)

Part B: Departmental Clearance

Department	Items to Check	Dues / Recovery (₹)	Cleared By (Name)
Reporting Manager	Handover note, files, pending work	[Amount]	[Reporting Manager]
IT	Laptop, accessories, email and system access, software licences	[Amount]	[Name]
Admin	ID card, access card, locker key, parking sticker, mobile / SIM	[Amount]	[Name]
Finance / Accounts	Salary advance, loan, travel advance, expense claims, corporate card	[Amount]	[Name]
Stores / Library	Tools, uniforms, books, safety equipment	[Amount]	[Name]
HR	Exit interview, leave balance, insurance, PF and gratuity forms	[Amount]	[HR Name]

Part C: HR Final Clearance

Form · Word

Exit Clearance Form

Download .docx

[Company Logo][Company Name]
EXIT INTERVIEW QUESTIONNAIRE
Employee Name:
[Employee Name]
Department:
[Department]
Date:
[Date]
Thank you for taking the time to share your experience at [Company Name]. Your honest answers will help us improve. Responses are confidential and are reviewed only by HR.
A. Your decision
1. What first made you start looking for another opportunity?
2. What does your new role offer that you could not find here?
3. Was there a specific event that confirmed your decision?
4. What could we have done to keep you?
B. Your role
1. How closely did your actual job match the description you were hired for?
2. Did you have the tools, information and resources to do your job well?
3. How manageable was your workload over the last six months?
Form · Word
Exit Interview Questionnaire
Download .docx
[Company Logo][Company Name]
EXIT REASON FORM
Record No.:
[Reference Number]
Date:
[Date]
Employee and Separation Details
Employee Name
Employee ID
Department
Grade / Level
Date of Joining
Last Working Day
Performance Rating (last cycle)
Separation Type (tick one)
- Voluntary – resignation
- Involuntary – termination for performance
- Involuntary – termination for misconduct
- Involuntary – retrenchment / role redundancy
- End of contract / non-renewal
- Retirement / superannuation
- Death or permanent disability
- Absconding / abandonment of service
Reason Codes
Form · Word
Exit Reason Form
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[Company Logo][Company Name]
EMPLOYEE RESIGNATION FORM
Form No.:
[Reference Number]
Date Received by HR:
[Date]
[Company Name]
[Company Address]

To be filled by the employee and submitted to the reporting manager and HR. Please write clearly.
Section A: Employee Details
Employee Name
Employee ID
Designation
Department
Work Location
Date of Joining
Reporting Manager
UAN (for PF transfer)
Personal Email
Mobile Number
Section B: Resignation Details
Date of Resignation
Notice Period as per Appointment Letter
Requested Last Working Day
Request for Notice Waiver / Buyout (Yes / No)
If yes, reason for early release
Form · Word
Employee Resignation Form
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[Company Logo][Company Name]
EMPLOYEE EXIT CHECKLIST
Employee Name:
[Employee Name]
Last Working Day:
[Last Working Day]
This checklist helps you complete your exit from [Company Name] smoothly. Tick each item as you finish it and contact [HR Name] at [HR Email] for help.
1. Right after resigning
- Submit signed resignation letter or HRMS request
- Receive acknowledgement or acceptance with confirmed last working day
- Agree the handover plan and successor with your manager
- Request notice waiver in writing, if needed
2. During the notice period
- Prepare a handover note covering tasks, contacts, passwords process and files
- Hold walkthrough sessions with your successor
- Submit pending travel and expense claims
- Clear any salary advance or loan as agreed with Finance
- Submit investment proofs for tax calculation in final salary
- Update your personal email, address and nominee details with HR
Checklist · Word
Employee Exit Checklist
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[Company Logo][Company Name]
HR EXIT CHECKLIST
Employee Name / ID:
[Employee Name] / [Employee ID]
Last Working Day:
[Last Working Day]
A. On receipt of resignation (owner: HR Executive)
- Log resignation in HRMS with date received
- Send acknowledgement within one working day
- Inform reporting manager and department head
- Confirm notice period and compute last working day
- Issue acceptance letter after approval
- Raise backfill requisition if approved
B. During notice (owner: HR Business Partner)
- Share notice period guidelines and employee exit checklist
- Issue exit clearance form to employee
- Notify IT and Admin of LWD and access cut-off
- Schedule exit interview
- Collect leave balance and attendance for the final month
- Process notice waiver or extension requests
C. On last working day (owner: HR Executive)
Checklist · Word
HR Exit Checklist
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[Company Logo][Company Name]
MANAGER EXIT CHECKLIST
Leaving Employee:
[Employee Name]
Manager:
[Reporting Manager]
Last Working Day:
[Last Working Day]
Within 48 hours of resignation
- Meet the employee privately to understand the decision
- Inform HR and agree whether a retention discussion is appropriate
- Agree the last working day in line with notice terms
- Identify business risks from this exit (clients, deadlines, knowledge)
Handover planning
- Nominate successor or interim owner for each responsibility
- Ask the employee for a written handover document by [Date]
- Schedule knowledge-transfer sessions and attend at least one
- Collect process notes, templates and SOPs owned by the employee
- Confirm location of all files on company drives
Stakeholders and team
Checklist · Word
Manager Exit Checklist
Download .docx