Data Breach Crisis Notification Report

1. Incident Overview

Date of Report Date and Time Detected Reported By Incident Summary

2. Breach Details

Type of Breach Location/System Impacted Number of Records/Data Affected Description of Breach

3. Response Details

Actions Taken Authorities/Organizations Notified

4. Impact Assessment

Type of Data Compromised Summary of Impact

5. Follow-Up

Next Steps/Recommendations Report Prepared By