EXIT INTERVIEW FORM
Completed by HR at separation to capture employee feedback and confirm clearance before full and final settlement.
[Company Name]
| Employee Name | [Employee Name] | Employee Code | [EMP-____] |
| Designation / Department | [Designation] | Date of Joining | [DD/MM/YYYY] |
| Last Working Day | [DD/MM/YYYY] | Reporting Manager | [Name] |
| Question | Response |
|---|---|
| Primary reason for leaving | [Better opportunity / Compensation / Relocation / Personal / Other] |
| Rating: Job role & responsibilities | [1–5] |
| Rating: Compensation & benefits | [1–5] |
| Rating: Relationship with manager | [1–5] |
| Rating: Work environment & culture | [1–5] |
| Would you recommend us as an employer? | [Yes / No] |
| Suggestions for improvement | [Comments] |
Exit Clearance / Handover:
| Item | Status | Cleared By |
|---|---|---|
| Company assets (laptop, ID card, SIM) | [Returned / Pending] | [Admin/IT] |
| Knowledge transfer / handover done | [Yes / No] | [Manager] |
| Dues / advances cleared | [Yes / No] | [Finance] |
_______________________ _______________________
Employee Signature & Date HR Signature & Date
Compliance note: Retain the completed form with the personnel file. Issue the relieving/experience letter and complete the full and final settlement, gratuity and PF/ESI exit formalities within statutory timelines after clearance.