Cybersecurity Incident Severity Assessment Form
Use this form to report and assess the severity of cybersecurity incidents for effective triage and response.
Reporter Full Name
*
First Name
Last Name
Reporter Email Address
*
example@example.com
Date and Time of Incident Discovery
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Brief Description of the Incident
*
Location or System(s) Affected (e.g., server name, workstation ID)
*
Type of Cybersecurity Incident
*
Malware Infection
Phishing/Email Attack
Unauthorized Access
Data Breach/Leak
Denial of Service (DoS/DDoS)
Insider Threat
Other
Which assets or data types are potentially impacted?
*
User Accounts
Sensitive Data (PII, company secrets)
Financial Records
Operational Systems
Email Systems
Other
Initial Impact Assessment
*
Rows
None
Minor
Moderate
Major
Critical
Business Operations Disruption
1
2
3
4
5
Data Loss/Exposure
6
7
8
9
10
Reputation Impact
11
12
13
14
15
Financial Impact
16
17
18
19
20
Is the incident currently contained?
*
Yes, fully contained
Partially contained
Not contained
How urgent is this incident?
*
Low Urgency
1
2
3
4
Critical Urgency
5
1 is Low Urgency, 5 is Critical Urgency
Incident Severity Rating (based on your assessment)
*
1
2
3
4
5
Additional Comments or Relevant Details
Submit Assessment
Should be Empty: