Template 6.4.2: Personal Checklist for Change
This checklist identies some of the factors that are important at an individual level
in relation to a person’s commitment to engage in a change process.
How to use it?
Staff may wish to complete this checklist and use the ndings as a basis for discussion
and action planning at team level.
These are the factors that I need to believe in to support the change Yes / No
I am clear about the reasons for change.
I agree change is necessary.
I am clear on the outcomes of the change for service users.
I have access to regular information.
I have access to information relevant to my role and the role of my team.
I have worked out the personal impact of the change.
My concerns have been listened to.
My concerns have been responded to.
I have had an opportunity to inuence decisions.
I have had an opportunity to be involved.
I believe the change is well planned.
I am clear on the change implementation Action Plan.
Milestones are being acknowledged and celebrated.
We are meeting change objectives.
I am feeling positive about the future.
Adapted from: The Workplace Change Project (2016) 
People’s Needs Deﬁning Change – Health Services Change Guide
People’s Needs Deﬁning Change Health Services Change Guide