Policy Manual sample

MDT Home Health Care Agency, Inc. EXIT INTERVIEW FOR HOME HEALTH CARE STAFF MEMBERS The Home Health Care Agency provides opportunities for terminating Home Health Care staff members to participate in exit interview. Employee Name: _____________________________ Interview Date: _________ Discuss Item Comment 9 Work environment_________________________________________________ _________________________________________________ 9 Work assignments_________________________________________________ _________________________________________________ 9 Staffing _________________________________________________ _________________________________________________ 9 Wage and salary _________________________________________________ _________________________________________________ 9 Personnel benefits_________________________________________________ _________________________________________________ 9 Job transfer - promotion opportunities__________________________________ _________________________________________________ 9 Job expansion-career development opportunities_________________________ _______________________________________________ 9 Interpersonal - intra departmental - peer relationships_____________________ ________________________________________________ 9 Informal - formal communication_______________________________________ ________________________________________________ 9 The Home Health Care staff member to which the staff member reported_______ ________________________________________________ ________________________________________________. 9 Education program ________________________________________________ ________________________________________________ The staff member’s reason for leaving Home Health Care Agency. 9 Significant factors that influenced the staff member to leave _____________________________________________________ _____________________________________________________ 9 What the staff member is looking for in a new job health care staff job satisfaction. _____________________________________________________ _____________________________________________________ 9 The staff member’s recommendations for improving Home Health Care staff member job satisfaction (see survey, if applicable) _________________________________________________ _______________________________________________________ 9 Other _______________________________________________________ _______________________________________________________ Interviewer Name/Title: __________________________ Signature:____________________ Date: ___________________ Employee Signature: ____________________ Home Health Agency. - - Personnel/Operations Policies B-65