Any · Template 33 of 40

DPIA and AI Impact Assessment Form

Use it when a new project or AI tool may be high risk for people’s data.

  • About 2 pages
  • 2 drafting notes in the margin
  • 7 clauses
  • Word (.docx)
  • England and Wales
  • Updated November 2026

What is in it

  1. Screening: do we need a DPIA?
  2. Description of the processing
  3. Consultation
  4. Necessity and proportionality
  5. Risks to individuals
  6. Additional questions for AI systems
  7. Measures and sign-off

Plus a schedule of the commercial details and signature blocks where the document needs them.

Read the opening

The first part of the template, as it reads in Word. Blanks are shown as lines; the drafting notes sit in the margin of the file.

DATA PROTECTION AND AI IMPACT ASSESSMENT

Project / feature / tool: ____________________ Date: ______________ Completed by: ____________________ Reviewed by (DPO / Policy Owner): ____________________

1. Screening: do we need a DPIA?

Question

Yes / No

Notes

Does the project use new technology, or AI, machine learning or automated decision-making that affects individuals?

☐ Y ☐ N

Does it involve large-scale processing of special category data (health, race, religion, sexual orientation, biometrics, genetic, trade union) or criminal data?

☐ Y ☐ N

How it works

  1. Pay by card. The download starts at once and the link keeps working.
  2. Open the Word file. Fill in the blanks, pick the options marked with boxes, read each note in the margin.
  3. Delete the notes and the notice box, then sign. Or send it to us for a fixed-fee check first.

Word template

£39 Instant download

One-off. No account needed. No VAT to add. Stripe emails a receipt you can use as an invoice.

Or fill it in online (platform plan)
  • Drafted by a solicitor for England and Wales
  • Drafting notes explain every choice
  • Instant download, link works again later
  • Last updated November 2026
  • £50 off a fixed-fee review once filled in (from £99)

Need more than one?

Complete template library, £299

All 40 documents, with the index and guide.