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Learning from leavers questionnaire

The information submitted on this form is strictly confidential

Section 1. Personal Details

Full name (optional)

Job title

Band

Directorate/Care Group*

Section/Ward

Line Manager

Date of leaving (dd/mm/yyyy)*

Length of service in final post

Leaver or internal transfer?*

Overall length of service

Section 2. Reason for leaving

What is the main reason for leaving

Please provide more details on the reason/s given above

Section 3. Overall job satisfaction

The following questions relate solely to your experience in your most recent job

What aspects of the job were most rewarding and why? (e.g. colleagues, environment, patient contact)

What aspects of the job were least rewarding and why?

Are there any aspects of this job which you would change to enable your role to be more effective? (Please identify why)

How would you describe your working relationship with your line manager?*

How would you describe your working relationships with your colleagues?*

Please use this space to expand on the previous two questions if needed

Section 4. Employment with the Trust

The following questions relate to your overall experiences and opinions of the Trust as an employer

What were the positive aspects of your employment with the Trust/YTHFM??

What were the negative aspects of your employment with the Trust/YTHFM??

What could have been done to improve your experience of working for the Trust/YTHFM:

By your colleagues?

By your line manager?

Head of service or senior manager?

Section 5. Further comments

Overall, did you enjoy working for the Trust/YTHFM?

Would you consider re-employment by the Trust/YTHFM in the future? (Please select the likelihood with 0 being ‘very unlikely’ and 10 being ‘’very likely’)*

May we share the information on this questionnaire with your line manager?*

Would you like to discuss your answers personally with a representative from the Human Resources department?*

If yes, please provide a phone number or email address we can contact you on

Section 6. Protected characteristics

Please support our work to reduce inequalities amongst staff, by completing the below:

Sex and gender – which of the following best describes you?*

Is your gender identity the same as the sex you were assigned at birth?*

Age*

Ethnicity - choose one option that best describes your ethnic group *

Sexual orientation *

What is your religion? *

Health - do you have any physical or mental health conditions or illnesses lasting or expected to last for 12 months or more?*

If yes, has the Trust / YTHFM made reasonable adjustments to enable you to carry out your work?

If yes, please share any information you are comfortable to, e.g. whether the adjustments have been effective / what else could have been considered

Caring responsibilities - do you have any children aged from 0 to 17 living at home with you, or who you have regular caring responsibility for?*

Do you look after, or give any help or support to family members, friends, neighbours or others because of either: long term physical or mental ill health / disability, or problems related to old age?*

If you have any caring responsibilities has the Trust / YTHFM made reasonable adjustments to enable you to balance your work and caring commitments?

If yes - please share any information you are comfortable to, e.g. if you have a child with additional needs, and about whether the support to balance your caring responsibilities has been effective / what else could have been considered

If there are any other comments you would like to make about support needed / provided in relation to protected characteristics – please include them below:

Thank you for taking the time and effort to complete this questionnaire. This will be retained for a period not exceeding six months and will be destroyed.

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