# Worker information and consent template

Replace every bracketed field. Use plain language and allow time for questions.
Keep this identifiable consent record separate from pseudonymous pilot outcomes.

## What is being tested

[Company] is testing three ways to turn non-sensitive business documents into a
draft action plan: manual work, an AI agent with an ordinary task prompt, and the
same agent with a structured document-to-action-plan protocol. The pilot is
trying to learn whether the protocol adds anything beyond the agent itself. No
benefit has been established.

## What participation involves

- You will receive a pseudonymous participant ID.
- A random allocation determines the order of the three methods.
- You will complete [number] comparable work items per method.
- We record active work time, elapsed time, corrections, blinded quality,
  material errors, a 1-to-7 burden rating, adoption preference, help requests,
  optional facilitator minutes, and coded safety events.
- We will ask for short follow-ups at about 30 and 90 days.
- Outputs remain drafts until the existing human approver accepts them.

## Your choice and protections

Participation is voluntary. Declining or withdrawing has no penalty and does not
affect your job, workload allocation, appraisal, pay, promotion, or access to
support. Individual outcomes will not be used for performance management or any
employment decision. You may pause a task or the pilot for a safety concern.

You may withdraw until [date/process]. Choose one and record it:

- [ ] Delete all outcome data linked to my participant ID where still feasible.
- [ ] Retain already collected pseudonymous data but make no further contact.

Explain any lawful or practical limit on deletion before consent: [text].

## Data boundary

Do not submit personal, sensitive, privileged, safety-critical, or commercially
sensitive documents. Use synthetic or redacted material where possible. Pilot
outcomes are stored at [approved destination], accessible to [roles], and
deleted by [date/method]. Raw agent logs are not retained. Identifiable consent
is stored separately at [restricted destination].

## Optional support

You may use the self-guided route or ask the approved optional adviser
[role/channel] for help. Possible roles include an accountant, bookkeeper,
trade-body adviser, or IT support person. This kit does not endorse them. Every
help request and support minute is recorded so support cost is not hidden.

## Risks, stop route, and contact

Possible risks include an incorrect or invented action, disclosure of unsuitable
data, excess burden, or an embedded document instruction influencing the agent.
Stop work and contact [incident role/channel]. The rollback is to the documented
manual workflow; no pilot output is used without human review.

## Consent

- [ ] I read and understood this information and had a chance to ask questions.
- [ ] I understand participation is voluntary and I may withdraw without penalty.
- [ ] I understand the recorded measures and 30/90-day follow-up.
- [ ] I understand individual results cannot be used for employment decisions.
- [ ] I consent to participate under the data and withdrawal terms above.

Name: [kept only in consent register]

Signature or approved consent record: [value]

Date: [YYYY-MM-DD]

Pseudonymous participant ID assigned separately: [P...]
