Change Management Readiness + Root Cause Analysis Survey

Change Readiness + Engagement: Root Cause Analysis Survey

Thank you for completing the survey below. All responses will be confidential to the Coach-Consultant.
Date

MonthDayYear
Date
Organization Name*
Name*

First NameLast Name
Email*
example@example.com
Your Role*
How long have you been in this role? *

Change Engagement: Root Cause Analysis
How many changes have you experienced at work within the last two years?*

1-34-6Too many to count!
From your perspective, in what area(s) are you and your team experiencing the most challenge? You can choose up to 3 areas.*

Culture and CommunityLeadership and ManagementBusiness Infrastructure: Systems, Policies, and ProcessesTeaming and CollaborationLearning and DevelopmentThe Pace and Amount of ChangeMotivation and PerseveranceStaff Capacity and ProductivityCommunication and Information SharingOther
In your own words, describe challenge #1.*
Provide an example.
In your own words, describe challenge #2.*
Provide an example.
In your own words, describe challenge #3.
Provide an example.
On the scale below, rate how are you feeling about the current climate and culture at work. 1= Very negative, 2= Bad, 3=Typical work environment, 4= Better than average, 5= Great!*

1

2

3

4

5

1 is Very negative, 5 is Great!

Readiness, Engagement, and Capacity for Responding to Challenge: I believe...*

	Yes	Not Sure	No
I am equipped to manage to the challenges being experienced at this time.
I have the supports I need psychologically and professionally to navigate through the pressures of change and challenge.
People here are working towards the same vision, mission, and outcome.
People here are committed to their work and are doing the best they can.
People that work here are competent and skilled to complete their responsibilities effectively.
As a team, we can find a way to meet our goals and deliverables satisfactorily.
We have the tools and resources needed to achieve our goals.
Our managers and leaders have our best interest in mind.
Our managers and leaders can and will support us through the challenges presented.
Our managers and leaders can manage the politics associated with the changes that come down the pipeline.
Our managers and leaders value the advocacy and input of the team.
Our managers and leaders are able to make timely and impactful decisions that move us forward towards our goals.

In this section, let's talk about emotional intelligence. Answer honestly and in the context of the experiences you are having in the workplace now.*

	Yes	No	Sometimes	Additional information
I have a good understanding of my emotions.
I recognize when I am emotionally triggered.
I am capable of controlling my emotions in the workplace.
I can explain why I feel the way I do about most things.
I am a good observer of other's emotions.
I am sensitive to the feelings and emotions of others.
I recognize the impact of my language, responses, and behaviors on others.
I am self- motivating.
I am able to control my temper when I experience difficulties and challenge.
I seek to resolve situations with my colleagues rationally.
I set goals for myself and try my best to achieve them.
I acknowledge and seek out help when needed.
I am receptive to the feedback of others in relation to my behavior.
I have coping methods to manage stress effectively.
I withdraw when overwhelmed and it takes a little while for me to re-engage with others.

Change Readiness + Engagement: Root Cause Analysis Survey