# AI Impact Assessment — {{Programme}}

**System purpose:** {{what it does, for whom}}
**Decision severity:** informational / advisory / consequential / high-stakes
**Affected groups:** {{users, subjects, third parties}}

## Fairness
Subgroups considered: {{list}}. Performance disparity measured: {{method}}. Findings: {{...}}

## Safety & misuse
Plausible misuse: {{list}}. Controls: {{input filtering, rate limits, output filtering}}.
Red-team date: {{date}}. Residual findings: {{...}}

## Transparency
Disclosure to users: {{where and how}}. Explanation available: {{what the user sees}}.
Challenge route: {{how a user contests an output}}.

## Human oversight
Oversight model: {{shadow/advisory/review/autonomous}}. Reviewer capability: {{training}}.
Override telemetry: {{how measured}}.

## Data
Provenance: {{sources, licence}}. Minimisation: {{what was excluded}}. Retention: {{period}}.

## Residual risk statement
{{Plain-language statement}} — accepted by {{accountable owner}} on {{date}}.