One row per field. A blank cell is a governance gap, not a formatting problem. The right-hand column records whether a change to that field invalidates your current evidence.
| Field | Value | Change trigger |
|---|---|---|
| Agent identifier and version | — | |
| Business owner | — | |
| Technical owner | — | |
| Approver (must differ from builder for high risk) | — | |
| Risk tier, with reasons | yes | |
| Intended use | yes | |
| Prohibited use | yes | |
| Model, provider and version | yes | |
| Model routing or fallback | yes | |
| Decoding settings that affect behavior | — | |
| System prompt version | yes | |
| Policy prompt version | yes | |
| Orchestrator and sub-agents | yes | |
| Tools, with declared side effects | yes | |
| MCP servers in scope | yes | |
| APIs and external endpoints | yes | |
| Data sources and retrieval corpora | yes | |
| Grounding policy | yes | |
| Memory type, persistence, write access | yes | |
| Credentials and assumable identities | yes | |
| Environments deployed | yes | |
| Last evaluation run identifier and date | — | |
| Policy version applied at last release | yes |