AI governance decision memo: a practical template.

Start with one defined decision

Use a separate memo for a defined AI use at procurement, pilot, deployment, expansion, or a material change. Assemble the people who understand the workflow and have authority over its consequences. Reference the supporting evidence so another reviewer can follow the judgment.

This is a web companion to the Authentic Intelligence workbook. You can copy the headings into your organization’s decision record and replace each prompt with your answers. Review the AIM framework before using the template.

The decision-memo template

1. Identify the decision

Record the proposal name, date, version, decision owner, and reviewers. State the specific decision AI would influence and what happens if no person intervenes.

2. Define scope and people affected

Name the workflow, affected people, roles, data, vendor, and system version. State what is outside the proposed scope. Classify the AI role as administration, decision support, or decision automation.

3. Record the Gate 0 judgment

State whether the proposed use can meet threshold obligations. List each unresolved condition, its owner, and the evidence needed before a next step is permitted.

4. Explain Rights, Reasons, and Results

Record the protections, explanations, and outcomes examined for the affected person, decision professional, and institution-community. Explain how disagreements and adverse evidence affected the judgment.

5. Examine the vendor and wider effects

Document the institution’s ability to verify, challenge, change, and stop the vendor-supported process. Include relevant workforce, environmental, security, resilience, and community effects.

6. State the decision and its reasons

Choose proceed, conditions, pilot, redesign, or decline. Explain why the evidence supports that outcome. Define exactly what is authorized now and what must not begin until conditions are satisfied.

7. Assign actions and authority

Name the person responsible for each condition, the evidence of completion, and the review point. Identify who accepts the evidence and who has authority to authorize, pause, or stop use.

8. Make recourse usable

Describe the notice and explanation available to affected people, the accessible route for raising a concern, who can reconsider the decision, and how the response will be recorded.

9. Set monitoring and stop conditions

Specify what will be monitored, by whom, and when. Define conditions that trigger investigation, restricted use, rollback, or suspension. Include vendor changes and a workable fallback process.

10. Preserve the decision record

Link the evidence, scorecards, reviews, unresolved objections, and approval record. Set the next review date or event. Record changes so later reviewers can see what was authorized and why.

What makes the memo useful?

A reader should be able to identify the authorized scope, understand the reasons, find the evidence, and reach someone who can act. A condition such as “maintain human oversight” needs an operational description: who reviews what, when they review it, what they can override, and what happens when they disagree.

Similarly, “monitor fairness” needs an appropriate evaluation approach, its limitations, a responsible reviewer, and a response to concerning findings. The memo should make an unresolved question visible and specify how it will be resolved before the next authorized step.

Keep the evidence and the judgment distinct. A vendor claim, a test result, an applicant concern, and a leadership decision each serve a different purpose in the record.

See how a completed memo changes a proposal

In the fictional AI hiring example, a team discovers that a proposed shortlist tool would automatically exclude applicants. Missing safeguards lead to a redesign decision. The completed memo records the limits of that decision, the evidence gaps, and the work needed before reconsideration.