Complete one document for each critical function that is currently performed or substantially supported by an AI system. The alternative pathway must be rehearsed annually for safety-critical functions. Evidence of rehearsal must be retained.
1. System Being Replaced
AI system name and the critical function it performs
[System name] · Function: [e.g. Automated fatigue risk assessment for shift scheduling]
Consequence of system unavailability
[Describe what happens operationally if this system is unavailable — e.g. "Shift scheduling cannot be completed using the automated tool; manual fatigue assessment is required for all shifts exceeding 10 hours."]
2. Manual Process Steps
| Step | Action | Responsible Role | Estimated Time | Tools / References Required |
|---|
| 1 | [e.g. Retrieve the Manual Fatigue Assessment Form from [location/system]] | [e.g. Site Safety Officer] | [e.g. 5 min] | [e.g. Form AI6-MANUAL-01; fatigue risk matrix] |
| 2 | [e.g. Complete manual fatigue assessment for each affected worker] | [e.g. Site Safety Officer] | [e.g. 10 min per worker] | [e.g. Fatigue risk matrix; worker hours records] |
| 3 | [e.g. Obtain sign-off from site supervisor before shift proceeds] | [e.g. Site Supervisor] | [e.g. 15 min] | [e.g. Signed hard copy to be retained on site] |
| 4 | | | | |
3. Rehearsal Record
| Date of Rehearsal | Conducted By | Participants | Outcome | Issues Identified | Corrective Actions |
|---|
| [DD/MM/YYYY] | [Name] | [Names / roles] | [ Successful / Partially successful / Unsuccessful ] | [None / Describe] | [None / Describe and reference follow-up] |
| | | | | | |
4. Next Scheduled Rehearsal
Date of next rehearsal (mandatory annually for safety-critical functions)
[DD/MM/YYYY]