AI Hallucination Monitoring Report Form
Report an AI hallucination incident by providing the system context, the incorrect output, the expected correction, the impact, and any supporting evidence.
Reporter Information
Reporter name
*
First Name
Middle Name
Last Name
Role / team
*
Work email address
*
example@example.com
Incident Context
Date of Incident
*
-
Month
-
Day
Year
Date
AI System / Model or Product Name
*
Input Prompt or Task Description
*
Output Channel or Context
*
Please Select
Chat interface
API response
Email draft
Document generation
Code completion
Voice assistant
Other
Hallucination Details
What did the AI get wrong?
*
What should the correct or expected information have been?
*
What impact or risk did this cause?
Severity of the incident
*
Low
Moderate
High
Critical
Evidence and Follow-up
Supporting evidence attached
Screenshots
Logs
Conversation transcript
Other
Upload supporting evidence
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