EXIT INTERVIEW

Employee's Name: 	_	Termination Date:  	 _

Location:  	          Interview Date:  		            

1. 	What is the reason for separation? 																																							

2. 	Does the employee understand and/ or agree with the
reason for separation? If no, give details: 

Yes                     No	 	

3. 	Does the employee feel (s)he has been treated fairly?
If no, give details:

Yes    	

No	 	

4.	Would the employee like to work for the facility again? 	Yes              	No              

5. 	Has the employee  returned facility property  (i.e., keys, credit cards, identification badge) issued to him/her?

Yes               	No

6.	Name of the employee's immediate supervisor: 

7.	What was the employee's opinion about the following?  If unsatisfactory, explain under  remarks
(Item 8).

A.  Job Assignment				        Favorable        Satisfactory         Unsatisfactory
B.  Progress					        Favorable        Satisfactory         Unsatisfactory
C. Salary					        Favorable        Satisfactory         Unsatisfactory	
D.  Supervisor					        Favorable        Satisfactory         Unsatisfactory
E.  Fellow Workers				        Favorable        Satisfactory         Unsatisfactory
F.  Promotional Opportunities		        Favorable        Satisfactory         Unsatisfactory
G.  General Working Conditions		        Favorable        Satisfactory         Unsatisfactory
H.  Training on Job by Supervisor		        Favorable        Satisfactory         Unsatisfactory

8.	Interviewer's Remarks: 

Name of Interviewer:											               NOTE:  Completed form should be included in employee's personnel file.

Northeastern Retail Lumber Association 12-11