# AI use case assessment record

Rafał Mokrowiecki · mokrowiecki.pl
v1.0 · 2026-11-01 · Blank template

A working decision record for a single use case. Complete it with the process owner, IT and relevant control functions. No automatic score or approval is generated.

An empty field is an evidence gap, not zero cost or risk.

## Context and accountability

### Company, use case, record version

Enter your company name. Assign a use case ID and document version.

…

### Accountable people

Process and decision owners; quality reviewer; IT; security and other required functions. Name who accepts risk.

…

### Problem and boundaries

Which activity should change, for whom, at what volume and with what effect? What is out of scope? Also consider a non-AI alternative.

…

## Baseline before the trial

### Baseline

Data source, dates, case count, sample selection, task difficulty, current end-to-end time, quality and spread. State gaps explicitly.

…

### Criteria agreed before testing

Measure, unit, denominator, target and stopping threshold; who assesses? Define a serious error. Missing evidence leaves a decision open, rather than implying zero errors.

…

## Data and controlled workflow

### Permitted data and tool

Data categories, sources, permissions, approved environment and version, retention, supplier access and required approvals. Do not enter secrets or customer data in this record.

…

### Verification, exceptions and fallback

Who checks outputs before use, and how? When does a person take over? How are errors reported, use stopped and the previous process restored?

…

## Trial plan and staff preparation

### Plan and reproducibility

Trial period and size, representation of difficult cases, group comparability, instruction and model/source versions. Limits to generalisation.

…

### Time, skills and support

Planned trial time, task-based training, reviewer competence, support channel, reported concerns and manager actions.

…

## Economics and results

### Cash expenditure and staff capacity

Separate one-off and recurring costs, period and currency, licences, implementation, data and support. Distinguish staff time from cash. Count verification included in task time only once.

…

### Results and evidence

Before/after figures, units, numerator/denominator, spread, serious errors, evidence source and deviations from plan. Separate observations, assumptions and gaps.

…

### How will the benefit be realised?

Will time released increase capacity, improve timeliness or reduce expenditure? Name an owner and mechanism; do not equate hours with cash.

…

## Decision and ongoing accountability

### Decision and rationale

Expand / improve and retest / stop / insufficient evidence. Compare evidence with criteria; document accepted risks, conditions and scope.

…

### Approval and next review

Who decided and when? Who monitors outcomes? Review date or trigger, retest conditions and person responsible for stopping use. A file entry is not an electronic signature.

…

---
NIST AI RMF 1.0 (2023): https://airc.nist.gov/airmf-resources/airmf/5-sec-core/
Independent template; no certification or full compliance claim. Use internally and adapt. Retain attribution when redistributing the original.