Date

Incident Location

Reporter's Name

Reporter's Email

Please provide your email address.

Reporter's Phone Number

Role

• IT Staff

• Employee

• Manager

Type of Data Breach

• Unauthorized Access

• Malware or Virus Attack

• Phishing Attempt

• Data Loss or Corruption

Detailed Description

Provide a clear account of what happened, including systems or data affected, how the breach was discovered, and potential causes.

Type of Data Affected

• Personal Identifiable Information (PII)

• Financial Data

• Intellectual Property

Immediate Actions Taken

Describe steps taken to contain the breach, notify stakeholders, or secure systems.

Relevant Files or Documents