Exit interview form template

An exit interview form is the one-page document an interviewer fills in during the conversation itself: header fields for who, when and how long they were here, the questions in a fixed order, rating boxes next to the ones that support a scale, and a place to flag anything that needs escalation before the meeting ends. It is not the question bank (see exit interview questions for what to ask and why) and it is not the summary sent to leadership (see exit interview report template for that). This is the paper, or the form field, that gets filled in live.

Below is a form you can copy into a document, a PDF, or your HRIS's custom form builder, a filled example, and the reasoning behind each field so you know what to change for your organization.

Why a fixed form, not a blank page

A blank notes page produces a different exit interview every time: different questions, different order, different level of detail, depending on who is running it and how the conversation drifted. A fixed form does three things a blank page cannot. It makes every exit interview comparable, so a pattern across five departures is visible instead of buried in five different note-taking styles. It stops an interviewer from skipping the one question they find awkward, because the field is sitting there empty and unmissable. And it gives a rating box next to the questions where a number is more useful than a paragraph, which is what makes the aggregate report possible later.

The trade-off is that a form can feel like a checklist to fill in rather than a conversation. The fix is not to drop the form, it is to hold it loosely: read from it, but let the employee's answer run long where it needs to, and add a note in the margin rather than cutting them off to move to the next field.

What to capture before the conversation starts

The header fields exist so the form is useful without anyone having to go back to the HRIS to find context. Fill these in before the meeting, from the employee's file, not by asking them to repeat information you already have.

• Employee name, role and department. Obvious, but skipped more often than you would expect on a rushed form.
• Manager name. Needed to spot a manager-specific pattern later; do not let the manager see this individual form.
• Hire date and last day. Tenure changes which questions matter — a four-month departure and a four-year departure are different conversations, covered in the next section.
• Interviewer name and relationship to the employee. A skip-level manager's read on a comment is different from an HR business partner's; record who is writing it down.
• Separation type. Voluntary resignation, layoff, termination for cause, or end of contract. This determines which question set applies; see the layoffs note in exit interview questions for why a resignation form does not fit an involuntary departure.
• Date and format of this conversation. In person, video call, or phone. A video call across time zones has its own logistics; see exit interview questions for remote employees.

The form template

Copy this into a document or your HRIS's form builder. The bracketed instructions are for the interviewer, not for print.

EXIT INTERVIEW FORM — CONFIDENTIAL

Employee: ______________________  Department: ______________________
Manager: _______________________  Tenure: __________ (hire date to last day)
Interviewer: ____________________  Relationship: ____________________
Separation type: [ ] Voluntary  [ ] Layoff  [ ] Termination  [ ] Contract end
Date of conversation: __________  Format: [ ] In person [ ] Video [ ] Phone

CONFIDENTIALITY NOTE (read aloud before starting)
"I'll share themes from this conversation with leadership, without your name
attached to specific quotes, unless you tell me something I'm required to
report — for example a safety, harassment or legal issue. Is that OK to
continue on that basis?"
[ ] Employee acknowledged

SECTION 1 — THE DECISION TO LEAVE
1. What is the main reason you're leaving?
   ____________________________________________________________
2. When did you start actively looking for something else, and what
   happened around that time?
   ____________________________________________________________
3. What would have needed to change for you to stay?
   ____________________________________________________________
   [ ] Nothing would have changed this (not preventable)

SECTION 2 — RATINGS (circle one; 1 = strongly disagree, 5 = strongly agree)
4. I had what I needed to do my job well.            1  2  3  4  5
5. I received useful feedback from my manager.        1  2  3  4  5
6. I understood how my role connected to company
   goals.                                             1  2  3  4  5
7. I would recommend this company to a friend
   looking for a job.                                 1  2  3  4  5
   Why / why not: ______________________________________________

SECTION 3 — MANAGER AND TEAM
8. How would you describe your relationship with your manager?
   ____________________________________________________________
9. Was there anything about how your team or workload was managed
   that contributed to your decision?
   ____________________________________________________________

SECTION 4 — OPEN
10. Is there anything that happened here that you think HR or
    leadership should know about, whether or not it's why you're
    leaving?
    ___________________________________________________________
    [ ] Nothing to escalate   [ ] ESCALATE — see note below

INTERVIEWER'S OWN NOTES (observations, not employee quotes)
____________________________________________________________
____________________________________________________________

ESCALATION (complete only if flagged above)
Nature of concern: __________________________________________
Routed to: __________________________  Date routed: __________

Interviewer signature: ___________________  Date: ____________

A filled example

An invented departure, filled the way a real form usually looks: short, plain, some fields terse.

Notice the rating on question 5 (useful feedback from the manager) is a 2 while the overall recommend-us rating in question 7 is a 4. That gap is the useful signal on this form: Marcus liked the company and disliked one specific, fixable thing about how he was managed.

Rating fields: how to score without faking precision

A five-point scale on a form invites false precision if you treat every average as meaningful. Two things keep it honest. First, always pair a rating with a short "why" field for the questions most likely to explain a low score (question 7 above); a 2 with no explanation is much less useful than a 2 with one sentence. Second, do not compute an average across forms with different interviewers unless you trust that every interviewer reads the scale the same way — a quick five-minute calibration where two interviewers rate the same recorded answer and compare is worth doing once before you rely on the numbers across a whole team.

Digital form or paper: what changes

Whichever you use, keep the escalation field and the interviewer's own notes separate from the employee's direct answers when you store them, so a reviewer never has to guess which is which months later.

Common mistakes

• Changing the question order or wording between interviews. Makes it impossible to compare forms later, which is the entire reason to use a fixed form.
• Letting the manager see the individual form. The confidentiality note on this form is a commitment; sharing the raw answer with the person it is partly about breaks it and every future exit interview with that team.
• Leaving the escalation field blank instead of checking "nothing to escalate." A blank field looks identical to a skipped question when someone reviews the form later. Make the reviewer's read unambiguous.
• Filing the form and never reviewing it. One form is an anecdote. Reviewing forms as a set is what finds a pattern, which is the whole point; see how to analyze exit interview data for the process.

Adjusting the form for tenure

A departure at three months and a departure at three years are different conversations, and one extra question on the form handles most of the difference. For a short tenure, add: "Was there anything about your first weeks here — onboarding, expectations, the actual work — that did not match what you were told when you accepted?" A pattern of short-tenure exits naming the same gap is usually an onboarding or hiring-pitch problem, not a retention problem, and it needs a different fix. For longer tenure, question 3 ("what would have changed this") tends to produce more specific, actionable answers, because a long-tenured employee has usually already tried to fix the problem themselves before deciding to leave.

What happens to this form next

A single form goes in the employee's file and gets reviewed for anything urgent the same week. Its other job is to become one row in a set: a quarter's worth of these forms is what the exit interview report template summarizes for leadership, and the method for turning a stack of them into themes and a decision is in how to analyze exit interview data. A form that never gets reviewed as part of that set is a compliance record, not a retention tool — worth saying to whoever asked you to start using one, before the first quarter goes by unreviewed.