This document provides a generic template that any Department Personnel Committee can adapt to reflect the broad impacts that have shaped their departmental faculty's activity and achivements in contexts of disruption. The adapted DPC Impact Statement can be attached to all departmental faculty personnel files for that year, providing important context and guidance to reviewers of any given faculty member's file - be they internal to the university, or external reviewers. This template is adapted from the DPC Pandemic Impact Statement first composed by the UMass Amherst Sociology Department's Personnel Committee in 2021, with thanks to the original creators.