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Exit Survey/Interview Form
COA form for exit survey/interview
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: COMMISSION ON AUDIT
Quezon City
EXIT SURVEY/INTERVIEW FORM
Date
OBJECTIVE: The idea of this survey is to ascertain and identify the problems and/or factor which caused the particular
employee to avail of optional retirement/resign from the Commission or transfer to another government agency. The
responses shall be collated and analyzed to guide us in our policies and efforts in further improving working conditions
in COA. Complete, truthful and frank comments from the employee and immediate supervisor concerned are welcome.
Constructive criticism is encouraged.
A. Em lo ee's Profile
Name (please print)
Age
Position
Salary
Penalty, if any
Administrative charges, if any
Mode of Separation/Date
Resignation
No. of times
promoted
Date of entry
in COA
No. of years/months
in COA
No. of years/months in in govt. service
outside COA (indicate agencies W
years/months in service)
Optional Retirement
Transfer
B. Em lo ee's Information Relevant to Se aration from COA
Place an X mark in the appropriate boxes.
Remarks portion (Item 7) may be filled up for elaboration/comments/other information.
1. SALARY
2. DESIGNATION/POSITION
3. PLACE OF WORK
Irrelevant to
Within convenient traveling distance
Education
Suffici ent
from home
Low
Work Experience
Far from home
Very Low
Too far from home
Training
4. VOLUME OF WORK
5.
NATURE OF WORK
Overloaded
Moderate
Challenging
.
Other
Unchallenging
Tedious
Light
Not related to education/course
6. REASONS FOR OPTIONAL RETIREMENT/RESIGNATION/TRANSFER
Health
To start a business
Migration
Family Issues (specify)
Higher Pay/Benefits from other Employer
Low morale due to:
Economic Dislocation
Explain:
Boredom
Explain:
Disappointment
Explain:
Lack of motivation
Explain:
Lack of recognition of work
Explain:
Other(s), please specify
. RESPONDENT'S REMARKS:
(Signature over printed name)
C. Supervisor's Evaluation Comments
To be accomplished by the Respondent's Immediate Supervisor:
. RESPONDENT'S INTERPERSONAL RELATIONSHIP IN THE ENTIRE UNIT/OFFICE
Honest/Morally upright
Feels intrigued
Wholesome
Impersonal
Lacks teamwork/cooperation
Apathetic
Lacks interest among employees
Unapproachable
Hostile
Incompetent
Other(s)
. IMMEDIATE SUPERVISOR'S REMARKS:
(Immediate Supervisor's name in
print and signature)
