F-AI3 AI Impact Assessment
File Reference : F-AI3 AI Impact Assessment
Date File Updated 13-08-26
File Format MS Word
No. of files 1
Category Form Templates
Tags: ISO 42001
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Clause 6.1.4 asks for an assessment of what an AI system could do to people, and it is a separate requirement from your risk assessment. The screening section at the top means a low-risk tool takes two minutes to dismiss with a reason on record, and only the systems that genuinely affect people get the full four stages.

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AI Impact Assessment Form Template

The AI system impact assessment required by ISO 42001 - a structured record of the potential consequences of an AI system for individuals, groups and society, with a screening step so the effort goes where it matters.

Clause 6.1.4 is explicit that this assessment is required, and it is distinct from the AI risk assessment. Risk assessment asks what could go wrong for the organisation. Impact assessment asks what the system could do to the people it touches. This form covers the second, and feeds the resulting risks into the register.

Built for ISO 42001 clause 6.1.4

The form is written around what the clause actually asks for:

  • Consequences for individuals, groups and society assessed on a risk basis
  • Intended use and foreseeable misuse both considered, across the life cycle
  • Applicable jurisdictions recorded, so obligations in the markets served are visible
  • Human oversight arrangements recorded wherever automated decision-making affects people
  • An outcome, conditions of use and a next review date, so the assessment stays current

What's Included in this AI Impact Assessment

A header recording the AI system, applicable jurisdictions, the reason for assessment and who completed it, then:

  • Screening - six questions determining whether a full assessment is needed. If every answer is no and the use is incidental and low-risk, the outcome is recorded as not required with a brief reason. Automated decision-making affecting people always requires the full assessment
  • Stage 1 - Use of the AI system - where, how and why it is used, through which process or function, and the provider, model and version
  • Stage 2 - Who is affected - customers, employees, applicants and service users, with vulnerable groups and people with protected characteristics noted explicitly
  • Stage 3 - How they are affected - potential impacts across the life cycle from intended use and foreseeable misuse, prompting on fairness and bias, privacy, transparency and the ability to question a decision, human autonomy, safety and wellbeing, access and inclusion, legal and human rights, and societal and environmental effects
  • Stage 4 - Controls, residual impact and human oversight - the mitigations in place or required, whether the residual impact is acceptable, and the named reviewer and trigger conditions where automated decisions affect people
  • Outcome and sign-off - proceed, proceed with conditions or do not proceed, conditions and restrictions, whether AI use is disclosed to interested parties, the next review date and AI lead approval

Who Needs an AI Impact Assessment?

Any organisation using AI where the output reaches a person - a customer, an employee, an applicant or the public. It is a requirement for ISO 42001 certification, and it is increasingly the document asked for in customer due diligence and by anyone assessing obligations under emerging AI regulation. It is also the assessment that gives you a defensible reason for not adopting an AI tool.

Included in the ISO 42001 Toolkit

This form is part of the ISO 42001 Toolkit - the policies, procedures, registers, audit checklists and guidance for running an AI management system in one download. The other three AI forms are listed on the F-AI forms page.

Pairs with the AI Risks and Controls Register

The impact assessment identifies what could happen to people. The risks that follow, their scoring and the Annex A controls applied are recorded on the ER42 AI Risks and Controls Register, so the assessment feeds the register rather than repeating it.

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