AI Incident Report Template

Article 62-aligned serious incident report template with notification workflow.
Category: Incidents • Risk level: High
# AI Incident Report Template (Serious Incidents)

> **Legal basis:** Art. 62 (reporting serious incidents and malfunctioning)
> **Goal:** Enable timely escalation, containment, authority notification, and corrective action tracking.

## 1) Incident Header
- Incident ID: [INC-YYYY-###]
- Detection timestamp (UTC): [YYYY-MM-DD HH:MM]
- Reporter: [Name/Role]
- System name/version: [System]
- Environment: [Prod/Test/Region]
- Severity: [Low/Medium/High/Critical]

## 2) Qualification Assessment
- Does event meet serious incident threshold? [Yes/No]
- Potential harm domains: [Health/Safety/Rights/Property]
- Affected population estimate: [Count]
- Confidence of incident classification: [High/Medium/Low]

## 3) Incident Description
- What happened: [Narrative]
- Trigger/event chain: [Timeline]
- First observed symptom: [Symptom]
- Current status: [Ongoing/Contained/Resolved]

## 4) Impact Assessment
- Direct impacts: [List]
- Potential downstream impacts: [List]
- Rights impacted (if any): [Rights]
- Financial/operational impact estimate: [Estimate]

## 5) Immediate Containment Actions
- Action 1 / timestamp / owner
- Action 2 / timestamp / owner
- Rollback/fallback activated? [Yes/No]
- Customer/user communication initiated? [Yes/No]

## 6) Authority Notification Track
- Competent authority identified: [Authority]
- Initial notification sent? [Yes/No]
- Notification timestamp: [YYYY-MM-DD HH:MM]
- Notification reference ID: [ID]
- Follow-up deadline(s): [Date/time]
- 72h internal target met? [Yes/No]

## 7) Root Cause Analysis
- Primary cause: [Cause]
- Contributing factors: [List]
- Why controls failed: [Explanation]
- Evidence references: [Logs/reports]

## 8) Corrective and Preventive Actions (CAPA)
- CAPA ID / owner / due date / status
- Validation of effectiveness plan
- Residual risk after CAPA

## 9) Post-Incident Review
- Lessons learned summary
- Policy/process updates required
- Monitoring updates required
- Stakeholder debrief completed? [Yes/No]

## 10) Sign-Off
- Incident manager: [Name/Date]
- Compliance/legal reviewer: [Name/Date]
- Executive approval: [Name/Date]
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