CUES Logo
CUES Adverse Impact Reporting Form
AI Governance Meeting Recording SOP

Adverse Impact Reporting Form

Use this page to document concerns related to AI systems, AI-assisted decisions, automated content, meeting intelligence tools, or any workflow that may create unfair, harmful, biased, inaccurate, or unintended outcomes for members, employees, partners, or the organization.

🛡 Applies to AI, automation, and meeting intelligence concerns 📋 Supports review, investigation, and follow-up 🔐 Designed for responsible reporting and documentation
Go to form Reporting guidance
Bias concerns Data concerns Access concerns Human review required

Executive Summary

CUES encourages employees, members, contractors, and partners to raise concerns when an AI-enabled system or AI-assisted workflow may have caused an unfair or harmful result. This page provides a standard way to document concerns so they can be reviewed consistently, routed to the right stakeholders, and tracked through resolution.

Use this form when: you believe an AI tool, automated decision, recommendation, summary, transcript, content generation process, or workflow created bias, inaccuracy, exclusion, privacy risk, reputational risk, or operational harm.

When to Report

Bias or unfairness

Report outcomes that appear discriminatory, uneven, exclusionary, or inconsistent across people, groups, or member segments.

Accuracy or harm

Report hallucinations, incorrect summaries, missing context, harmful recommendations, or automation errors that affected work or decisions.

Privacy or access

Report issues involving sensitive data exposure, unauthorized recording, retention concerns, broken permissions, or inaccessible outputs.

  • AI-generated meeting notes omitted a key decision or assigned actions to the wrong person.
  • An AI workflow produced content or recommendations that may disadvantage a person or group.
  • A recording, transcript, or summary was stored in the wrong place or shared too broadly.
  • An automated process used data in a way that seems inconsistent with policy or expected consent.

Adverse Impact Reporting Form

This page is a formatted reporting template. Submission workflow can later be connected to SharePoint, Microsoft Forms, Power Automate, or another approved CUES intake process.

Do not include sensitive data unless the intake method is approved for it.
Static prototype page. Connect this button to an approved CUES submission workflow when ready.

Review Process

  • Intake: Capture the concern, affected system, and impact details using the standard form.
  • Triage: Route the report to the appropriate governance, IT, HR, legal, or business owner based on the nature of the issue.
  • Assessment: Review available evidence, validate facts, assess risk, and determine whether corrective action is required.
  • Follow-up: Document remediation, communications, policy updates, or system changes needed to reduce repeat issues.
  • Closure: Track disposition and retain records according to approved governance and retention practices.

FAQ

Can I report anonymously?
That depends on the final intake workflow CUES chooses. This prototype includes named fields, but the production version can be adapted to support anonymous or confidential reporting where appropriate.
Does filing a report mean a policy violation definitely occurred?
No. This form is for raising concerns and documenting potential adverse impacts so they can be reviewed fairly and consistently.
CUES Adverse Impact Reporting Form • Companion page to the AI Governance policy and supporting SOP resources.