Exit Survey

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* 1. Optional Information

Name:

City:

Personal Email Address:

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* 2. Former County Health Department (CHD), Division, or Office:

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* 3. Former Bureau/Section Name:

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* 4. Please indicate your satisfaction as it relates to the general conditions of the position from which you vacated.

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Physical working conditions	Physical working conditions Very Dissatisfied	Physical working conditions Dissatisfied	Physical working conditions Neutral	Physical working conditions Satisfied	Physical working conditions Very Satisfied
Type of work	Type of work Very Dissatisfied	Type of work Dissatisfied	Type of work Neutral	Type of work Satisfied	Type of work Very Satisfied
Volume of work	Volume of work Very Dissatisfied	Volume of work Dissatisfied	Volume of work Neutral	Volume of work Satisfied	Volume of work Very Satisfied
Job security	Job security Very Dissatisfied	Job security Dissatisfied	Job security Neutral	Job security Satisfied	Job security Very Satisfied
Agency procedures	Agency procedures Very Dissatisfied	Agency procedures Dissatisfied	Agency procedures Neutral	Agency procedures Satisfied	Agency procedures Very Satisfied
Office procedures	Office procedures Very Dissatisfied	Office procedures Dissatisfied	Office procedures Neutral	Office procedures Satisfied	Office procedures Very Satisfied
Relationship with fellow employees	Relationship with fellow employees Very Dissatisfied	Relationship with fellow employees Dissatisfied	Relationship with fellow employees Neutral	Relationship with fellow employees Satisfied	Relationship with fellow employees Very Satisfied
Relationship with supervisor	Relationship with supervisor Very Dissatisfied	Relationship with supervisor Dissatisfied	Relationship with supervisor Neutral	Relationship with supervisor Satisfied	Relationship with supervisor Very Satisfied
Challenge of work	Challenge of work Very Dissatisfied	Challenge of work Dissatisfied	Challenge of work Neutral	Challenge of work Satisfied	Challenge of work Very Satisfied
The importance of your work	The importance of your work Very Dissatisfied	The importance of your work Dissatisfied	The importance of your work Neutral	The importance of your work Satisfied	The importance of your work Very Satisfied
The responsibilities of your job	The responsibilities of your job Very Dissatisfied	The responsibilities of your job Dissatisfied	The responsibilities of your job Neutral	The responsibilities of your job Satisfied	The responsibilities of your job Very Satisfied
Professional development (training etc.)	Professional development (training etc.) Very Dissatisfied	Professional development (training etc.) Dissatisfied	Professional development (training etc.) Neutral	Professional development (training etc.) Satisfied	Professional development (training etc.) Very Satisfied
Accomplishments of your work unit	Accomplishments of your work unit Very Dissatisfied	Accomplishments of your work unit Dissatisfied	Accomplishments of your work unit Neutral	Accomplishments of your work unit Satisfied	Accomplishments of your work unit Very Satisfied
Pay received for work performed	Pay received for work performed Very Dissatisfied	Pay received for work performed Dissatisfied	Pay received for work performed Neutral	Pay received for work performed Satisfied	Pay received for work performed Very Satisfied
Opportunities for advancement	Opportunities for advancement Very Dissatisfied	Opportunities for advancement Dissatisfied	Opportunities for advancement Neutral	Opportunities for advancement Satisfied	Opportunities for advancement Very Satisfied
Other benefits	Other benefits Very Dissatisfied	Other benefits Dissatisfied	Other benefits Neutral	Other benefits Satisfied	Other benefits Very Satisfied
Overall working for the agency	Overall working for the agency Very Dissatisfied	Overall working for the agency Dissatisfied	Overall working for the agency Neutral	Overall working for the agency Satisfied	Overall working for the agency Very Satisfied

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* 5. If you are accepting employment elsewhere, what advantages do you feel your new employer offers that you have not found here?

Better working condition

More challenging position

More job security

Better chance for advancement

Higher salary

Better relationship with other employees

Better relationship with supervisor

More work

Less work

More hours

Less hours

Other (please specify)

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* 6. Have you accepted another job in state government?

Yes

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* 7. What influenced you to leave this office?

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* 8. Please indicate your feelings about the supervision you received while employed with this office.

	Very Dissatisfied	Dissatisfied	Neutral	Satisfied	Very Satisfied
Utilization of your abilities	Utilization of your abilities Very Dissatisfied	Utilization of your abilities Dissatisfied	Utilization of your abilities Neutral	Utilization of your abilities Satisfied	Utilization of your abilities Very Satisfied
Amount of assistance received	Amount of assistance received Very Dissatisfied	Amount of assistance received Dissatisfied	Amount of assistance received Neutral	Amount of assistance received Satisfied	Amount of assistance received Very Satisfied
Effectiveness of assistance received	Effectiveness of assistance received Very Dissatisfied	Effectiveness of assistance received Dissatisfied	Effectiveness of assistance received Neutral	Effectiveness of assistance received Satisfied	Effectiveness of assistance received Very Satisfied
Interest taken in your progress	Interest taken in your progress Very Dissatisfied	Interest taken in your progress Dissatisfied	Interest taken in your progress Neutral	Interest taken in your progress Satisfied	Interest taken in your progress Very Satisfied
Recognition of ideas and accomplishments	Recognition of ideas and accomplishments Very Dissatisfied	Recognition of ideas and accomplishments Dissatisfied	Recognition of ideas and accomplishments Neutral	Recognition of ideas and accomplishments Satisfied	Recognition of ideas and accomplishments Very Satisfied
Relationship with fellow employees	Relationship with fellow employees Very Dissatisfied	Relationship with fellow employees Dissatisfied	Relationship with fellow employees Neutral	Relationship with fellow employees Satisfied	Relationship with fellow employees Very Satisfied
Fair and impartial treatment	Fair and impartial treatment Very Dissatisfied	Fair and impartial treatment Dissatisfied	Fair and impartial treatment Neutral	Fair and impartial treatment Satisfied	Fair and impartial treatment Very Satisfied

Exit Survey

Question Title

* 1. Optional Information

Question Title

* 2. Former County Health Department (CHD), Division, or Office:

Question Title

* 3. Former Bureau/Section Name:

Question Title

* 4. Please indicate your satisfaction as it relates to the general conditions of the position from which you vacated.

Question Title

* 5. If you are accepting employment elsewhere, what advantages do you feel your new employer offers that you have not found here?

Question Title

* 6. Have you accepted another job in state government?

Question Title

* 7. What influenced you to leave this office?

Question Title

* 8. Please indicate your feelings about the supervision you received while employed with this office.

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* 9. Please comment on what you feel could be done to help make the Department a better place to work.