Incident Report Form

INCIDENT REPORT FORM

Please act promptly to report any data breaches. Please complete this form as soon as possible

If you feel that the breach is serious or you require advice please do not hesitate to contact the Compliance Officer for guidance in the first instance. You should also liaise with your supervisor and ensure that he/she is aware of the breach.

NOTIFICATION OF DATA SECURITY BREACH

Date incident was discovered * +

Date of incident * +

Place of incident *

Name of person reporting incident *

Contact details of person reporting incident *

Brief description of incident or details of the information lost *

Has any personal data been placed at risk?

Brief description of any action taken at the time of discovery

Signature *

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