stay interview form template

Employee Retention and Engagement Feedback Form

Instructions for Use

• Schedule this session in a private, neutral environment to encourage open and honest dialogue between the manager and the employee.
• Document the responses accurately during the conversation; if the employee prefers, allow them to complete the form independently and return it within [Number] business days.
• Treat all feedback as confidential and use the insights to develop a concrete action plan for improving the employee’s experience and long-term retention.

Parties and Definitions

This form is intended for use between [Company Name] ("the Company") and [Employee Name] ("the Employee"). The "Retention Discussion" refers to the structured dialogue conducted on [Date of Discussion] regarding the Employee’s current role, satisfaction, and professional trajectory.

Operative Clauses

1. Current Role Satisfaction: What aspects of your current role at [Company Name] do you find most engaging or rewarding? [__________]

2. Motivation Drivers: What keeps you working here, and what factors, if any, have caused you to consider other opportunities elsewhere? [__________]

3. Management and Support: How would you describe the support you receive from your direct supervisor? Are there specific areas where you feel you need more guidance or autonomy? [__________]

4. Professional Development: Do you feel that your current career path aligns with your long-term professional goals? What skills or experiences would you like to acquire in the next [Number] months? [__________]

5. Work-Life Integration: How would you rate your current workload and the balance between your professional responsibilities and personal commitments? [__________]

6. Organizational Culture: If you could change one thing about the way the Company operates or its internal culture, what would it be? [__________]

7. Retention Commitment: Are there specific changes or resources that would significantly increase your desire to remain with the Company for the next [Number] years? [__________]

8. Confidentiality and Follow-up: The Company acknowledges that this feedback is provided in good faith. The manager agrees to review these responses and provide a follow-up action plan by [Follow-up Date].

Signature and Acknowledgment

By signing below, the parties acknowledge that the feedback provided during this session has been captured accurately and will be utilized to foster a more productive and satisfying work environment.

Employee Signature: __________ Date: [] Printed Name: []

Manager Signature: __________ Date: [] Printed Name: [] Title: [__________]

Legal Disclaimer: This document is a general framework and does not constitute legal advice. Employment laws vary significantly by jurisdiction; please consult with qualified legal counsel or your Human Resources department to ensure compliance with local, state, and federal regulations.