DATA BREACH PROCESS FORM

Section 1 Informed of Potential Breach

Date of Breach

Time of Breach

Description of breach

Cause of breach

Which system(s),if any, are affected:

Has corrective action occurred to remediate the breach or potential breach?

Person who informed of breach

Information received by

Date of receipt of information

Is personal information involved?

Has there been unauthorised access, disclosure, loss of personal information in circumstances where access to the information is likely to occur?

Describe the type and extend of personal information involved

Does the breach include multiple individuals?

Provide details of people or type of people who now have access

Determine where there is (or could be) a real risk of serious harm to affected individuals

Determine whether there could be media or stakeholder attention as a result of the breach or potential breach

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