Critical Infrastructure Cyber Incident Report
1. Reporter Information
Organization Name
Contact Person
Contact Email
Contact Phone
2. Incident Details
Date & Time Detected
Incident Location(s)
Type of Incident
Malware
Ransomware
Phishing
Data Breach
DDoS
Unauthorized Access
Other
Description of Incident
3. Impact Assessment
Systems Affected
Estimated Impact (services disrupted, data exposed, etc.)
4. Actions Taken
Immediate Actions Taken
External Agencies Notified
5. Additional Comments