# APEC CBPR Self-Assessment Template

## Organization Information

| Field | Value |
|-------|-------|
| Organization Name | [Name] |
| Economy | [APEC economy] |
| Accountability Agent | [Agent name] |
| Privacy Contact | [Name, email, phone] |
| Business Description | [Description of activities involving personal information] |
| APEC Economies Covered | [List of economies where PI is collected/transferred] |
| Individuals Covered | [Approximate number] |
| Categories of PI | [List] |
| Sensitive PI Categories | [Health, financial, children's data, biometric — if applicable] |

## Principle Assessment Summary

| Principle | Requirements | Met | Status |
|-----------|-------------|-----|--------|
| 1. Preventing Harm | /4 | | [ ] Compliant [ ] Partial [ ] Gap |
| 2. Notice | /6 | | [ ] Compliant [ ] Partial [ ] Gap |
| 3. Collection Limitation | /5 | | [ ] Compliant [ ] Partial [ ] Gap |
| 4. Uses | /5 | | [ ] Compliant [ ] Partial [ ] Gap |
| 5. Choice | /6 | | [ ] Compliant [ ] Partial [ ] Gap |
| 6. Integrity | /4 | | [ ] Compliant [ ] Partial [ ] Gap |
| 7. Security | /7 | | [ ] Compliant [ ] Partial [ ] Gap |
| 8. Access/Correction | /6 | | [ ] Compliant [ ] Partial [ ] Gap |
| 9. Accountability | /7 | | [ ] Compliant [ ] Partial [ ] Gap |
| **Total** | **/50** | | |

## Detailed Requirement Assessment

### Principle 1: Preventing Harm

| Req ID | Requirement | Met? | Practice Description | Evidence |
|--------|-----------|------|---------------------|---------|
| CBPR-1 | Privacy risk assessments conducted | [ ] Y [ ] N | | |
| CBPR-2 | Technical and organizational safeguards | [ ] Y [ ] N | | |
| CBPR-3 | Incident response procedures | [ ] Y [ ] N | | |
| CBPR-4 | Complaint resolution mechanisms | [ ] Y [ ] N | | |

*[Continue for all 50 requirements across 9 principles]*

## Gap Remediation Plan

| Req ID | Gap Description | Remediation Action | Owner | Target Date |
|--------|----------------|-------------------|-------|-------------|
| | | | | |

## Management Attestation

I attest that the information provided in this self-assessment is accurate and complete, and that [Organization Name] is committed to complying with the APEC CBPR Program Requirements.

| Field | Value |
|-------|-------|
| Name | [Senior Executive Name] |
| Title | [Title] |
| Date | [YYYY-MM-DD] |
| Signature | [Signature] |