| Date/Time of Breach | |
|---|---|
| Discovered By | |
| Reported By | |
| Department | |
| Location |
| ☐ Unauthorized Access | ☐ Malware/Ransomware |
| ☐ Data Leak/Exposure | ☐ Lost/Stolen Device |
| ☐ Other: |
| Type/Description | Estimated Volume |
|---|---|
| Name/Role | Date Notified | Contact Method |
|---|---|---|
| Escalated To | Date/Time | Next Steps |
|---|---|---|