CA-T1 Algorithmic Impact Assessment Worksheet
Verification required. This is a working template, not a regulator-approved form. Where it names an instrument or a date, the claim comes from secondary sources or from memory of the law and is a pointer to check. This is not legal advice.
How to use: This is a blank form. Copy it and fill in the empty cells and blanks for your system. To copy it, follow the "Suggest an edit to this page" link in the footer to reach its Markdown source.
Wiki controls: AI-CTRL-011, AI-CTRL-037. The worksheet is modelled on the idea of the federal Algorithmic Impact Assessment [Reported]. It is a working draft; use the official tool for federal work.
| Area | Question | Answer | Impact level contribution |
|---|---|---|---|
| Decision | Type of decision and its effect on rights, health and economic interests | ||
| Reversibility | Can the effects be reversed? | ||
| Duration | How long do the effects last? | ||
| Data | Personal and sensitive data used | ||
| Automation | Degree of human involvement | ||
| Controls | Testing, monitoring, explanation, recourse |
Outcome
| Field | Entry |
|---|---|
| Impact level (1 to 4), set by the owner | |
| Mitigations required at that level | |
| Sign-off |