Personal Data Breach Notification

Information required to report a breach in personal data security

Name of your organisation

Did the data breach occur:

by an employee by a contractor or consultant through a third-party (e.g. work placement provider, agent, recruitment platform, cloud storage provider) other

Your name

Has this breach been reported to the ICO?

No Yes

What has happened

How was the breach discovered?

On what date was the breach discovered?

What time was he brach discovered on that day?

On what date did the breach occur (if known)?

Which categories of personal data are affected?

Racial or ethnic origin Political opinions Religious or philosophical beliefs Trade union membership Sex life Sexual orientation Health data Basic personal identifiers (e.g. Name) Identification (e.g. user ID) Financial (e.g. bank details) Official documents (e.g. passport) Locational Genetic or biometrics Criminal convictions Not yet known Other

Number of personal records involved?

How many data subjects could be affected?

Types of data subjects affected:

Employees Users Subscribers Students Customers Prospective Customers Patients Children (under 13) Vulnerable adults Not yet known Other

Potential consequences of the breach?

What is the likelihood that data subjects will experience significant consequences?

Very Likely Likely Neutral Unlikely Very unlikely

Was the breach caused by a cyber incident?

Yes No Don't know

Has confidentiality, integrity or availablity of your information systems been affected?

Yes No Don't know

What is the impact to your organisation?

High - Lost all ability to deliver critical services Medium - Lost ability to provide critical service to some users Low - No, or low, loss of efficiency ; still provide critical services Not yet known

What recovery time do you estimate?

Regular - predictable with existing resources Supplemented - predictable with more resources Extended - Not predictable, need extra resources Not recoverable Already recovered Not yet known

What actions have already been taken?

Have you told the affected data subjects about the breach?

Yes - they have been told We are in the process of telling them They are already aware No, but we are planning to No, we've decided not to We haven't decided yet Other

Are you planning to tell any other organisations about the breach?

Yes No Don't know

Please attach any additional information you may have

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