ACPT Exit Form - SS Survey

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* 2. Date of Joining

Date/Month/Year

Date

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* 3. Last working Day

Date/Month/Year

Date

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* 4. Position

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* 5. Employee No:

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* 6. Section

ACPT

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* 7. Department

Non-Official Sites

Official Sites

Shared Services

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* 8. What is your assessment of the following AKH-ACPT?

	Excellent	Good	Fair	Poor	Very Poor
Salary & Benefits	Salary & Benefits Excellent	Salary & Benefits Good	Salary & Benefits Fair	Salary & Benefits Poor	Salary & Benefits Very Poor
Vacation / Leave Policies	Vacation / Leave Policies Excellent	Vacation / Leave Policies Good	Vacation / Leave Policies Fair	Vacation / Leave Policies Poor	Vacation / Leave Policies Very Poor
Medical Benefits	Medical Benefits Excellent	Medical Benefits Good	Medical Benefits Fair	Medical Benefits Poor	Medical Benefits Very Poor
Training-Education Programs	Training-Education Programs Excellent	Training-Education Programs Good	Training-Education Programs Fair	Training-Education Programs Poor	Training-Education Programs Very Poor
Office Location	Office Location Excellent	Office Location Good	Office Location Fair	Office Location Poor	Office Location Very Poor
Work Station	Work Station Excellent	Work Station Good	Work Station Fair	Work Station Poor	Work Station Very Poor

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* 9. How would you rate your Line Manager on each of the following points?

	Excellent	Very Good	Fair	Poor	Very Poor
Treats staff fairly with respect	Treats staff fairly with respect Excellent	Treats staff fairly with respect Very Good	Treats staff fairly with respect Fair	Treats staff fairly with respect Poor	Treats staff fairly with respect Very Poor
Recognizes staff accomplishments	Recognizes staff accomplishments Excellent	Recognizes staff accomplishments Very Good	Recognizes staff accomplishments Fair	Recognizes staff accomplishments Poor	Recognizes staff accomplishments Very Poor
Promotes cooperation	Promotes cooperation Excellent	Promotes cooperation Very Good	Promotes cooperation Fair	Promotes cooperation Poor	Promotes cooperation Very Poor
Resolves complaints and problems	Resolves complaints and problems Excellent	Resolves complaints and problems Very Good	Resolves complaints and problems Fair	Resolves complaints and problems Poor	Resolves complaints and problems Very Poor
Encourages feedback and suggestions	Encourages feedback and suggestions Excellent	Encourages feedback and suggestions Very Good	Encourages feedback and suggestions Fair	Encourages feedback and suggestions Poor	Encourages feedback and suggestions Very Poor
Concerned about staff heath and safety	Concerned about staff heath and safety Excellent	Concerned about staff heath and safety Very Good	Concerned about staff heath and safety Fair	Concerned about staff heath and safety Poor	Concerned about staff heath and safety Very Poor
Encourages training and development of associates	Encourages training and development of associates Excellent	Encourages training and development of associates Very Good	Encourages training and development of associates Fair	Encourages training and development of associates Poor	Encourages training and development of associates Very Poor
Keeps associates informed	Keeps associates informed Excellent	Keeps associates informed Very Good	Keeps associates informed Fair	Keeps associates informed Poor	Keeps associates informed Very Poor

Others: (please specify)

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* 10. How would you rate your Department Head on each of the following points?

	Excellent	Very Good	Fair	Poor	Very Poor
Treats staff fairly with respect	Treats staff fairly with respect Excellent	Treats staff fairly with respect Very Good	Treats staff fairly with respect Fair	Treats staff fairly with respect Poor	Treats staff fairly with respect Very Poor
Recognizes staff accomplishments	Recognizes staff accomplishments Excellent	Recognizes staff accomplishments Very Good	Recognizes staff accomplishments Fair	Recognizes staff accomplishments Poor	Recognizes staff accomplishments Very Poor
Promotes cooperation	Promotes cooperation Excellent	Promotes cooperation Very Good	Promotes cooperation Fair	Promotes cooperation Poor	Promotes cooperation Very Poor
Resolves complaints and problems	Resolves complaints and problems Excellent	Resolves complaints and problems Very Good	Resolves complaints and problems Fair	Resolves complaints and problems Poor	Resolves complaints and problems Very Poor
Encourages feedback and suggestions	Encourages feedback and suggestions Excellent	Encourages feedback and suggestions Very Good	Encourages feedback and suggestions Fair	Encourages feedback and suggestions Poor	Encourages feedback and suggestions Very Poor
Concerned about staff heath and safety	Concerned about staff heath and safety Excellent	Concerned about staff heath and safety Very Good	Concerned about staff heath and safety Fair	Concerned about staff heath and safety Poor	Concerned about staff heath and safety Very Poor
Encourages training and development of associates	Encourages training and development of associates Excellent	Encourages training and development of associates Very Good	Encourages training and development of associates Fair	Encourages training and development of associates Poor	Encourages training and development of associates Very Poor
Keeps associates informed	Keeps associates informed Excellent	Keeps associates informed Very Good	Keeps associates informed Fair	Keeps associates informed Poor	Keeps associates informed Very Poor

Others: (please specify)

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* 11. How would you rate the following in your specific Department? (NOS, OS, and SS)

	Excellent	Very Good	Good	Fair	Poor	Very Poor
Cooperation within your department	Cooperation within your department Excellent	Cooperation within your department Very Good	Cooperation within your department Good	Cooperation within your department Fair	Cooperation within your department Poor	Cooperation within your department Very Poor
Cooperation with other departments	Cooperation with other departments Excellent	Cooperation with other departments Very Good	Cooperation with other departments Good	Cooperation with other departments Fair	Cooperation with other departments Poor	Cooperation with other departments Very Poor
On-the-job training	On-the-job training Excellent	On-the-job training Very Good	On-the-job training Good	On-the-job training Fair	On-the-job training Poor	On-the-job training Very Poor
Advancement opportunity	Advancement opportunity Excellent	Advancement opportunity Very Good	Advancement opportunity Good	Advancement opportunity Fair	Advancement opportunity Poor	Advancement opportunity Very Poor
Communications within your department	Communications within your department Excellent	Communications within your department Very Good	Communications within your department Good	Communications within your department Fair	Communications within your department Poor	Communications within your department Very Poor
Morale	Morale Excellent	Morale Very Good	Morale Good	Morale Fair	Morale Poor	Morale Very Poor

Additional comments:

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* 12. What is your opinion of working at AKH-ACPT?

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* 13. Have working conditions changed during your tenure?

Yes

If yes, in what way?

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* 14. What did you like most about working at AKH-ACPT?

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* 15. What did you like least about working at AKH-ACPT?

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* 16. Would you recommend a friend to pursue employment with AKH-ACPT?

Yes, definitely

Yes, with reservations

If No/Yes with reservations, please explain:

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* 17. May we share the information you have provided (without your name) with others in:

	Yes	No
AKH Management?	AKH Management? Yes	AKH Management? No
Department Management?	Department Management? Yes	Department Management? No

ACPT Exit Form - SS

Shared Services

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* 1. Name

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* 2. Date of Joining

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* 3. Last working Day

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* 4. Position

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* 5. Employee No:

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* 6. Section

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* 7. Department

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* 8. What is your assessment of the following AKH-ACPT?

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* 9. How would you rate your Line Manager on each of the following points?

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* 10. How would you rate your Department Head on each of the following points?

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* 11. How would you rate the following in your specific Department? (NOS, OS, and SS)

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* 12. What is your opinion of working at AKH-ACPT?

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* 13. Have working conditions changed during your tenure?

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* 14. What did you like most about working at AKH-ACPT?

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* 15. What did you like least about working at AKH-ACPT?

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* 16. Would you recommend a friend to pursue employment with AKH-ACPT?

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* 17. May we share the information you have provided (without your name) with others in:

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* 18. What suggestions would you offer to make AKH a better place to work?