Privacy Impact Assessment – Access Control Table (Section D)

Access Control Table (PIA Annotated Template - Section D)

Document Purpose and Overview

A Privacy Impact Assessment (PIA) describes how proposed administrative practices or information systems may affect the privacy of the individuals who are the subjects of the information. 

This document is intended to be adapted by the custodian when submitting a PIA in Section D: Access Control Table. This table provides the Office of the Information and Privacy Commissioner (OIPC) with information about the various roles in the clinic and the type of access to information permitted for each role.  

The proper form to use is the PIA Annotated Template. This template is intended to assist community-based custodians in completing PIAs. It can be accessed on this page on the Alberta Health website.

Instructions for Use

• Download the Access Control Table template
• Adjust the table to resemble your clinic's roles and positions
• Add the number of staff in each role
• Remove all highlighting and add your clinic's letterhead

Download Word Template