HR – Exit | Ozarks Community Health Center

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Employee Information

First Name(Required)

Last Name(Required)

Primary Location(Required)

Length of Service(Required)

Which of the following describes your job(Required)

Would you work for this company again?(Required)

Would you recommend employment with OCHC to a friend?(Required)

If you would not recommend, please provide an explanation

Please comment on how satisfied you were with each of the following aspects of your job:

Your overall work experience(Required)

Hours worked(Required)

Geographic Location(Required)

Definition of your role and responsibility(Required)

The nature of the work required in your role(Required)

Opportunities for advancement and development(Required)

Performance review and development process(Required)

Ability to provide input into issues that affected your job(Required)

Salary(Required)

Paid Time Off (PTO)(Required)

Health/Dental/Life Insurance(Required)

Retirement Planning(Required)

Other Benefits(Required)

Work Environment(Required)

Relationship with Immediate Supervisor/Manager(Required)

Relationship with Staff in your Business Area(Required)

Relationship with Staff in OTHER Business Areas(Required)

Please comment on how satisfied you were with each of the following aspects of your job:

Orientation (General/Clinical)(Required)

Orientation (Departmental)(Required)

Training and Development Opportunities(Required)

Computer and/or Meditech Training(Required)

Access to Training Programs(Required)

Availability of Educational Opportunities(Required)

Communication of Company Direction and Policy(Required)

Feedback on your Performance(Required)

Communication of decisions and issues affecting you(Required)

Competence of your immediate manager(Required)

Having tools/resources to complete your job(Required)

Culture of supporting all staff to develop and reach their potential(Required)

Culture of respecting individual differences(Required)

Culture of providing a workplace free of harassment and bullying(Required)

During your employment were you aware of any instance that someone knowingly made, used, or caused a false record or statement to get a false/fraudulent claim paid?(Required)

If yes, please explain in the box below:

Please use the space below for any additional comments you would like to make.

Disclaimer and Signature

Employee Signature(Required)

Completion Date(Required)

OCHC Exit Interview Survey

Employee Information

Please comment on how satisfied you were with each of the following aspects of your job:

Please comment on how satisfied you were with each of the following aspects of your job:

Disclaimer and Signature