Incident Register

Compliant with EU AI Act – Art. 73 (Serious incident reporting) & Art. 20 (Corrective actions)

Incident ID / Reference number AI System name Organisation / Provider Contact e-mail Date and time of incident Date incident was detected Date of incident registration Incident type Is this a serious incident requiring notification? (Art. 73) Risk classification of AI system Detailed description of the incident Root cause (if known) Contributing factors Severity of incident Impact on health and safety Impact on fundamental rights Number of affected persons Description of affected persons or groups Geographic scope Was human oversight present during the incident? Immediate actions taken (Art. 20) Current status Was the incident reported to authorities? (Art. 73) Authority notified (if applicable) Date of notification to authorities Corrective actions planned (Art. 20) Preventive measures implemented Timeline for resolution Lessons learned System modifications required Responsible person / Incident owner Additional remarks I confirm this incident report is accurate and complete to the best of my knowledge.