AI Collaboration Consent & Attribution Form (Template)

AI Collaboration Consent & Attribution Form

Purpose: Make AI use transparent for collaborators and audiences, preserve accountability, and reduce risk by documenting who used AI, for what steps, what the data sources and limitations were, how outputs should be attributed, and how to challenge or override AI-generated content.

Instructions

Please complete this form whenever AI tools materially contributed to an output (drafts, summaries, analysis, recommendations, images). Keep a copy with meeting notes, decision records, deliverables, or public-facing materials as appropriate. Adapt language to your organization’s policies.

Project / Output

Project / Output Title: ________________________________

Date: ________________________________

Prepared by (name & role): ________________________________

AI Tools & Steps Used

AI tools used: (check or list) e.g., ChatGPT, Claude, Bard, internal LLM, summarizer, code assistant, image generator, other:

__________________________________________________________

Steps where AI was used (select or describe):

• Authoring / draft generation
• Summarization
• Editing / rewriting
• Analysis or data synthesis
• Image or visual generation
• Decision-support / options generation
• Other: __________________________

Brief description of how AI was used:

__________________________________________________________

Data Sources & Known Limitations

Data sources provided to or referenced by the AI (public sources, internal data, uploaded documents):

__________________________________________________________

Known limitations, caveats, or confidence concerns (e.g., hallucination risk, training cutoff, missing domain data):

__________________________________________________________

Sensitivity & Privacy

Does this output include personal, confidential, regulated, or otherwise sensitive data? (yes / no) ______

If yes, specify what kind of data and safeguards applied:

__________________________________________________________

Attribution & Suggested Language

Use clear attribution to preserve transparency and trust. Suggested short attribution snippets you can paste into headers, footers, or notes:

• "Portions of this draft were generated using [ToolName] and reviewed/edited by [PersonName]."
• "Summary produced with assistance from [ToolName]; final content reviewed by [PersonName]."
• "Image created with [ToolName]. Refer to internal image-sourcing notes for usage rights."

Preferred attribution line for this output:

__________________________________________________________

How to Question or Override AI Outputs

Who to contact if you suspect an error or bias: Name / Role / Email: ___________________________________

Override process (how to escalate and document decisions):

1. Record concern in the project notes with a brief rationale.
2. Notify the Audit Owner listed below and the original author.
3. Decide whether to retract, revise, or annotate the output.
4. Log the final decision (who, when, why) in decision records.

Audit & Refresh

Audit owner (person responsible for review & retention of provenance): ________________________________

Suggested refresh cadence for reviewing AI usage and tooling (choose one):

• Event-driven (when tool or process changes)
• Quarterly
• Annually
• Other: __________________

Distribution & Publication

Intended distribution channels for this output: (internal notes, team meeting, public report, customer communication, regulatory filing, press release, other)

__________________________________________________________

Special publication instructions (e.g., include attribution on slides, add appendix with methods):

__________________________________________________________

Approval & Sign-off

Approver (name & role): ________________________________

Approval date: ________________________________

Signature / confirmation: ________________________________

Quick Compliance Checklist

• Attribution language included where outputs will be consumed publicly.
• Sensitivity/privacy checks completed and recorded.
• Known limitations and confidence notes attached to the output.
• Audit owner assigned and refresh cadence selected.
• Override/escalation path documented.

Notes for Teams & Librarians

Keep a copy of this completed form with the project’s records. Use it to seed periodic audits, training examples, and model-risk assessments. Adapt wording to comply with legal, regulatory, or sector-specific requirements before external publication.