GDPR Data Breach Notification
to Supervisory Authority
1. Details of the Data Controller
Name of Organisation:
Address:
Contact Person:
Email:
Telephone:
2. Description of the Personal Data Breach
Date and Time of the Breach:
Date and Time the Breach was Detected:
Nature of the Breach:
Categories and Approximate Number of Data Subjects Concerned:
Categories and Approximate Number of Personal Data Records Concerned:
3. Consequences of the Breach
Description:
4. Measures Taken or Proposed
Measures to Address the Breach:
Measures to Mitigate Possible Adverse Effects:
5. Contact Details for Further Information
Contact Person:
Email:
Telephone: