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Change Request Readiness & Stakeholder Impact Survey

Gauges how a specific proposed change request lands with the people it affects — awareness, perceived risk, resource readiness, and willingness to support it — built for change managers, PMOs, and transformation leads preparing a rollout or approval decision. The AI follow-up interview digs into each respondent's single biggest concern and what would turn hesitation into active support.

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Sample questions

A preview of what’s in the template. Every question is editable before you launch.

12 questions · ~7 min
Q01
Message

Thanks for taking a few minutes on this! We'd like your honest take on (Replace with the name/description of the proposed change request) — including what's confusing, what's risky, and what would help you adopt it. About 5-6 minutes. (Template note: replace all bracketed placeholders with your specific change request before sending.)

Q02
Multiple ChoiceRequired

Which best describes your current awareness of (Replace with name of proposed change request)?

  • I haven't heard of it
  • I've heard about it but don't know the details
  • I understand the basics
  • I understand it in detail, including how it affects my role
Q03
Opinion ScaleRequired

How clearly has the reason for this change been communicated to you?

Scale: 1 – 5
Min:Not clear at allMax:Extremely clear
Q04
MatrixRequired

How much do you agree with each statement about this change request?

4 rows × 5 columns
  • The timing of this change makes sense
  • I will have the resources (time, tools, training) I need to adopt it
  • Leadership has been visible and consistent in supporting this change
  • I understand exactly what will be different for me day-to-day
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q05
Opinion ScaleRequired

If this change request were approved and rolled out today, how ready is your team to adopt it?

Scale: 1 – 7
Min:Not ready at allMax:Completely ready
Q06
Multiple ChoiceRequired

What's the single biggest risk or concern you have about this change request?

  • Impact on my day-to-day workload
  • Lack of clarity on the end goal
  • Insufficient training or support
  • The timeline is too aggressive
  • Effect on team roles or headcount
  • (Replace with another concern specific to your change request)
  • I don't have a concern
Q07
Point AllocationRequired

You have 100 points to allocate. Split them across the types of support below based on what would most help you adopt this change successfully.

  • Clearer communication about why this change is happening
  • Hands-on training on the new process or tool
  • More time before the change takes effect
  • Visible sponsorship from leadership
  • Extra staffing or resources during the transition
Allocate 100 points
Q08
Opinion ScaleRequired

How likely are you to actively support this change with your team or colleagues, rather than just tolerate it?

Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q09
AI Interview

Explore the respondent's single biggest concern about this change request in depth: what specifically worries them, what evidence or reassurance would ease it, and whether a past change at this organization is shaping their reaction. If they said they have no concerns, probe what would move them from passive acceptance to being an active champion. If their support rating was low, ask the one thing that would raise it.

Q10
Multiple Choice

Which team or department are you part of?

  • (Replace with department A)
  • (Replace with department B)
  • (Replace with department C)
  • Prefer not to say
Q11
Multiple Choice

How long have you been with the organization?

  • Less than 1 year
  • 1-3 years
  • 4-7 years
  • 8+ years
  • Prefer not to say
Q12
Message

Thanks for your candid feedback! We'll use these responses to refine the rollout plan, address the biggest concerns first, and target training and communication where they're needed most.

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Opens with a friendly context-setting message and closes with a thank-you/next-steps message, so respondents understand why their input matters and what happens next.
  • Combines an opinion scale, a matrix, and a constant-sum question so change managers can measure communication clarity, agreement across multiple statements, and how respondents would allocate support resources — not just a single satisfaction score.
  • Includes an AI follow-up interview that digs into each respondent's single biggest concern about the change and what would turn hesitation into active support, surfacing detail a fixed-choice form can't capture.
  • Captures department and tenure alongside sentiment questions, so PMOs and transformation leads can segment readiness and risk by team before a rollout or approval decision.

Jotform

Change Request Form Template

This is a static intake form for logging a change request (fields like description, justification, requested date) rather than a survey that gauges how stakeholders feel about a proposed change. It's fielding-ready out of the box but built for request capture/tracking, not sentiment or readiness assessment.

What it does well

  • Quick to deploy with Jotform's drag-and-drop builder
  • Customizable fields and layout for logging request details
  • Can plug into Jotform's broader workflow/automation ecosystem

Where it falls short

  • No adaptive follow-up questioning — respondents only answer the fixed fields provided
  • No automated quality scoring or auto-generated stakeholder-readiness report
  • No mechanism to probe the 'why' behind a respondent's concern, since it's a submission form, not an interview

Typeform

Change Request Form Template

A conversational-style form for capturing a change request one question at a time, which improves completion experience over a plain form but is still a static predefined question set. It's aimed at documenting a request, not measuring stakeholder awareness, risk perception, or willingness to support a change.

What it does well

  • Polished, mobile-friendly conversational UI
  • Easy to embed and share as a standalone link
  • Simple to customize question wording and branding

Where it falls short

  • No AI-driven follow-up probing on individual concerns — question flow is fixed for every respondent
  • No voice interview option or guided screen-share tasks
  • No automated per-response scoring or auto-generated report on readiness/risk

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.

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