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Report a Data Breach
Name of person completing this form
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Position/Department
*
Date and time breach occurred
*
Day
Month
Year
Time
:
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Description of the breach
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How was the breach discovered?
*
Location (physical or digital)
*
Describe what happened
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Types of personal data affected:
*
Name/contact details
Health or safeguarding information
Financial information
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Other
Approximate number of individuals affected
*
Immediate actions taken
*
Contained breach
Notified Data Protection Officer
Informed IT Support
Recalled email or secured access
Other
Details of actions taken
Potential impact on individuals
*
Low risk (limited exposure, unlikely harm)
Medium risk (some risks of distress or inconvenience)
High risk (risk of identity theft, emotional distress or harm)
Who have you notified? (Under GDPR, serious breaches must be reported to the ICO within 72 hours)
*
Data Protection Lead notified
ICO notified
Individuals involved notified
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