Name of the EIS
Name of the Client
Which uP! Event did the client attend most recently:
1. What was the ‘Critical’ problem stated by the client, and in what ways was it affecting the client and/or their ecosystem?
2. In your assessment, does the above-stated problem qualify as ‘critical’ to solve right now or can it wait till the next uP! event / consultation event?
3. Please list below Immediate ATC as you diagnosed in the call:
Notes for Change Agent
(Refer notes below):
What Adjustment must be made immediately
Also mention any alternate procedures. If it’s parts integration, mention specific parts and outcome (Note: This will be passed on to Change Agent, and hence the intention and communication has to be clear so that the Change Agent can perform procedures effectively for the client)
Significance of this Adjustment:
Why is this adjustment critical to solve the current challenge and how does this adjustment also contribute to the larger picture (consequences) for the client?
What do you expect as an outcome of this specific Adjustment? Also, what are the Test condition notes you have for the Change Agent?
Any notes for the Change Agent:
Eg:- Resourceful states recommendation with context etc.
4. Any other ATC (need not be handled immediately, but you have diagnosed that these adjustments have to be done for this person, perhaps later. Knowing this now may even be useful while Change Agent is doing procedures on the client):
5. List any Undone/Incomplete Procedures from the ATC list last given to the client and also, List procedures Done but have not worked for the client:
Status (Not done, Incomplete, Did not work)
6. What Level of Change Agent can deliver this changework? If you think only one/two specific change agents can deliver this, then please mention their names.
Master Change Agent
7. When would you like to Review this client, after Change work?
8. If there is no need for Procedures to be done by a Change Agent immediately, please mention What Change (mindset/behavior etc.) was done on the call with you and how do we validate say 2 weeks from now, if the undesirable states/behaviors are repeating themselves or are they on the right track in this regard?
9. What are some measurable state and behavioral shifts that you anticipate and expect that need to be validated over the next few weeks?
10. Any other comments: