Dear Roechling employee,
Thank you for assisting us by agreeing to complete the following exit interview form. Please answer each question honestly and feel free to be as open and frank as you wish. The information you provide will assist us in making Roechling Engineered Plastics a better place to work and improved service provider.
Please note that the first four questions have an asterisk (*) next to them. These denote that an answer is required in order to complete the exit interview process. Our objective in collecting this data is to determine potential adverse impacts and or trends that may be affecting REP employees.
Again, thank you for your cooperation.
1. Employee Information.*
Name Position Date Hire Date Termination Date
White African-American Hispanic Asian Native American
3. Gender.*
Female Male
4. Location.*
Gastonia, NC Ontario, CA Greensburg, PA
5. Please indicate why you are leaving the company and what conditions initiated the leave.
Employee Benefits
Please rate the following using this scale: 1= excellent 2= good 3= fair 4= poor
6. Salary.
Excellent Good Fair Poor
7. Insurance coverage.
8. Employee orientation.
9. Initial training.
10. Physical working conditions.
11. Ongoing training.
Policies and Procedures
12. Recruitment process.
13. Open door policy.
14. Performance review process.
15. Posting job openings.
Employee Relations
16. Keeping employees informed.
17. Cooperation among employees.
18. Fair treatment of employees.
19. Upholding company values.
20. Morale in your area.
21. Morale overall.
22. Cooperation between employees and management.
23. Resources given to employees to do their Job.
Relationship With Supervisor
Please rate the following using this scale: 1= always 1= usually 3= seldom 4= never
24. Supervisor resolved complaints and concerns promptly.
Always Usually Seldom Never
25. Supervisor listened to suggestions from employees.
26. Supervisor encouraged cooperation.
27. Supervisor treated me fairly.
28. Supervisor was helpful and knowledgeable.
29. Supervisor exhibited quality leadership.
31. Do you have another job?
No Yes [If yes [Go to question 31a]
31a. Please complete the following information.
New Job Title Company Name City and State New Salary
Yes No
38a. Why?
40. Do you think our company lives up to the values that have been chosen? If no, which value(s) did we not live up to?
No [Go to question 41] Yes
41. How did we not live up to our values?