Data Breach Report Form
Please act promptly to report any data breaches. If you discover a data breach, please notify your Head of Department and complete this form immediately.
Date Incident was discovered:
Email address of person completing the form:
Brief description of the incident or details of the information lost:
Number of Data Subjects affected, if known:
Has any personal data been placed at risk?
Please provide details
Brief description of any action taken at the time of discovery: