Privacy Impact Assessment Template
Template for Privacy Impact Assessment. Customize this template for your specific needs.
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Document: Privacy Impact Assessment
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Version 1 • Last updated 7/30/2026
Privacy Impact Assessment
1. Project Details
Project Name: [INSERT PROJECT NAME] Project Manager: [INSERT NAME] Date of Assessment: [INSERT DATE] Project Description: [DESCRIBE WHAT THE PROJECT DOES. INCLUDE WHY YOU ARE DOING IT AND WHAT IT INVOLVES]
2. Information Flow
What personal information are you collecting? [LIST ALL DATA TYPES E.G. NAMES, ADDRESSES, PHONE NUMBERS, EMAILS, CREDIT CARD DETAILS, HEALTH INFO]
How are you collecting it? [DESCRIBE METHOD E.G. ONLINE FORM, PAPER APPLICATION, OVER THE PHONE, IN PERSON]
Where will the information be stored? [DESCRIBE STORAGE E.G. CLOUD SERVER, LAPTOP HARD DRIVE, FILING CABINET]
Who will have access to it? [LIST STAFF MEMBERS, CONTRACTORS, THIRD PARTIES OR AGENCIES WHO CAN SEE THE DATA]
Do you plan to share the information with anyone else? [YES/NO] [IF YES, LIST WHO AND WHY]
3. Privacy Risk Assessment
Are you collecting information that is considered sensitive? [YES/NO] [NOTE: SENSITIVE INFO INCLUDES HEALTH RECORDS, RELIGIOUS BELIEFS, CRIMINAL RECORD, SEXUAL ORIENTATION]
Do you have consent to collect and use this information? [YES/NO/NOT APPLICABLE] [EXPLAIN HOW YOU GOT CONSENT OR WHY IT IS NOT NEEDED]
Could this project cause harm to individuals if the data was lost or stolen? [YES/NO] [DESCRIBE THE POTENTIAL HARM]
4. Compliance with Australian Privacy Principles
APP 1 (Open and Transparent): [EXPLAIN HOW YOU WILL TELL PEOPLE ABOUT YOUR DATA HANDLING PRACTICES]
APP 6 (Use or Disclosure): [EXPLAIN IF YOU ARE USING THE DATA FOR THE REASON YOU COLLECTED IT. IF NOT, DO YOU HAVE CONSENT?]
APP 11 (Security of Personal Information): [LIST THE SECURITY MEASURES YOU HAVE IN PLACE. E.G. PASSWORD PROTECTION, ENCRYPTION, LOCKED FILING CABINETS]
5. Risk Mitigation Plan
| Risk Identified | Likelihood (High/Med/Low) | Impact (High/Med/Low) | Mitigation Strategy | Responsible Person |
|---|---|---|---|---|
| [DESCRIBE RISK 1] | [SELECT] | [SELECT] | [WHAT WILL YOU DO TO FIX IT?] | [WHO WILL DO IT?] |
| [DESCRIBE RISK 2] | [SELECT] | [SELECT] | [WHAT WILL YOU DO TO FIX IT?] | [WHO WILL DO IT?] |
6. Approval
I confirm that this assessment has been completed accurately and that risks have been identified and mitigated.
Signature: [SIGN HERE] Name: [PRINT NAME] Role: [JOB TITLE] Date: [DATE]
About this Template
Part of the Privacy Impact Assessment document collection
Document Type
Privacy Impact Assessment
A tool to help businesses identify and reduce privacy risks when handling personal information. It ensures you meet Australian legal standards.