Lontra HR · Working template
Stay interview action and follow-up worksheet
Confirm what the employee asked, distinguish a proposed request from an accepted action and give each line an update date.
Use this worksheet with a fictional example first, then adapt it to your organization’s process. Keep personal or confidential information in your authorized systems.
- Agree who can access the notes before using the worksheet.
- Use the employee’s words and invite corrections.
- Label commitments only after the accountable owner accepts them.
- Set an update date even when the final decision will take longer.
- Keep individual details within the agreed access arrangements.
Click a cell to edit it locally. Print or save as PDF to keep your completed copy. Changes are not sent to a server.
| Topic in the employee’s words | Request, check or commitment | Next action and accountable owner | Update date | Employee confirmation and outcome |
|---|---|---|---|---|
| [What is working and should be preserved] | [Request or accepted commitment] | [What the manager or process owner will do] | [Date] | [Employee’s correction or confirmation] |
| [One recent friction point] | [Check] | [Specific process detail to confirm; owner] | [Date] | [Finding and what remains open] |
| [Development or support request] | [Request] | [Criteria or opportunity to review; decision owner] | [Date] | [Answer and reason] |
| [First action agreed together] | [Commitment] | [Action accepted by someone able to deliver it] | [Date] | [Delivered, adapted or outstanding; next step] |
Prepared by Lontra HR Editorial · 10 November 2026 · Editorial review copy. Filled examples, where present, are fictional and demonstrate the method.