Security Incident Report Form

1. Incident Details

Date and Time of Incident:

Date and Time of Report:

Location of Incident:

Reported By:

Incident Type:

• Data Breach
• Unauthorized Access
• Phishing Attack
• Malware Infection
• Denial of Service (DoS) Attack
• Physical Security Breach
• Other (please specify): __________

2. Incident Description

Brief Description of the Incident:

Systems or Data Affected:

Initial Detection Method:

Immediate Actions Taken:

3. Impact Assessment

Extent of Impact:

Potential Risks:

4. Investigation Details

Investigation Team Members:

Investigation Findings:

Evidence Collected:

5. Resolution and Recovery

Steps Taken to Resolve the Incident:

Time to Resolution:

Follow-Up Actions:

6. Reporting and Documentation

Internal Notifications:

External Notifications:

Final Report Submitted By:

Date of Final Report Submission:

7. Lessons Learned

What Went Well:

Areas for Improvement:

Recommendations:

8. Signatures

Incident Handler:

Supervisor: