<PSR No - Project Name>

CHANGE READINESS SURVEY

Project <Name>

Change Readiness Survey

Version <#>

Your feedback is important for us to serve you better!

 <PSR No - Project Name>
CHANGE READINESS SURVEY

DOCUMENT INFORMATION    

Document Name Change Readiness Survey

Project SR Number, Title <PSR #, Title>
Project Manager <Name>
Change Management Team <Name, Role>
Document Version
Document Status Draft
Date Released <dd-mm-yyyy>

REVIEW
Name Role Review/ Approve Date of Review/ Sign-off
<Name> <Role> <Review/ Approve> <dd-mm-yyyy>

REVISION HISTORY
Version Issue Date Version Description Author
<Version> <dd-mm- <Insert comments as <Author>
yyyy> appropriate>

DISTRIBUTION OF FINAL DOCUMENT

Name Role
<Name> <Role>
   
   
   
   

Full Name  (Optional) :

Your feedback is important for us to serve you better!

 <PSR No - Project Name>
CHANGE READINESS SURVEY

Department :

Please circle the rating that best describes your evaluation for the following questions.

RATING REMARKS
EVALUATION ASPECTS 1-Strongly Disagree 3-Agree Reasons/ Improvement
2-Disagree 4-Strongly Agree suggestions
LEADERSHIP
I believe our leaders understand the impacts of
1 1 2 3 4
the change on the organisation.
I believe our leaders understand the impacts on
2 customers and have plans in place to manage 1 2 3 4
these impacts.
I believe our leaders are strongly supportive of
3 1 2 3 4
the change.
I believe our leaders are actively involved in
4 1 2 3 4
preparing for the change.
I believe our leaders are effectively managing
5 1 2 3 4
implementation issues and risks.
I believe our leaders understand and are
6 1 2 3 4
managing staff expectations.
I believe our leaders have a detailed plan for
7 1 2 3 4
this implementation activities.
COMMUNICATION
I know the objectives and goals of <insert
8 1 2 3 4
project/initiative name>.
I understand how my organisation can benefit
9
from this initiative/project.
I believe our managers are fully informed about
10 1 2 3 4
the Project changes.
I believe our supervisors and the front line staff
11 1 2 3 4
are fully informed about Project changes.
My superior and I know the key
12 1 2 3 4
implementation activities and dates.
I know how to obtain help and support on my
13 1 2 3 4
queries related to this project.
CAPABILITY
I understand the changes to my role and job
14 1 2 3 4
function post-Project.
I believe effective coaching/training for new
15 skills will take place to help me prepare for the 1 2 3 4
change.
I believe the redesigned business processes will
16 1 2 3 4
enable us to be more effective.

17 I believe the <insert system/project name> is 1 2 3 4

Your feedback is important for us to serve you better!

 <PSR No - Project Name>
CHANGE READINESS SURVEY

RATING REMARKS
EVALUATION ASPECTS 1-Strongly Disagree 3-Agree Reasons/ Improvement
2-Disagree 4-Strongly Agree suggestions
put in place to improve our ways of working.
OWNERSHIP
I believe the discomfort caused by the changes
18 1 2 3 4
is being managed effectively.

19 I know my Expert User / Change Agent. 1 2 3 4

I believe Expert Users are empowered to

20 1 2 3 4
provide support where and how it is needed.
I believe my involvement is encouraged to
21 1 2 3 4
support this initiative.
ADDITIONAL FEEDBACKS / SUGGESTIONS / COMMENTS:
22 Additional comments:

Thank you for your feedback.

Your feedback is important for us to serve you better!