GDPR Data Breach Notification Form
Organization Details
Organization Name
Contact Person
Email Address
Phone Number
Details of the Breach
Date Breach Occurred
Date Breach Discovered
Description of the Breach
Type(s) of Personal Data Involved
Categories of Data Subjects Affected
Impact and Mitigation
Likely Consequences of the Breach
Measures Taken to Address Breach
Have Data Subjects Been Notified?
Yes
No
Has the Data Protection Authority Been Notified?
Yes
No
Additional Information
Additional Relevant Information