Contextualized Assessment Questionnaire Form
Use this form to capture the context, current situation, assessment criteria, and desired outcome for a contextualized assessment questionnaire.
Assessment Context
Respondent name or identifier
*
Organization, team, or project context
*
Primary use case category
*
Operations
Customer Experience
Product Development
Process Improvement
Training and Enablement
Strategy and Planning
Compliance and Risk
Other
Current Situation and Needs
Current situation being assessed
*
Urgency / impact level
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Best describes the current challenge or goal
*
Clarify the issue
Resolve an immediate problem
Improve an existing process
Plan a new initiative
Other
Contextual Criteria Matrix
Criteria Assessment
*
Rows
Importance
Current Readiness
Expected Impact
Criterion 1
1
2
3
Criterion 2
4
5
6
Criterion 3
7
8
9
Rating by Criterion
Rows
Rating
Criterion 1
10
Criterion 2
11
Criterion 3
12
Outcome and Follow-up
Expected Result
*
Preferred Follow-up Priority
*
High
Medium
Low
Submit
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