College Cyber Incident Response Report Form
Report a cybersecurity incident so it can be reviewed, triaged, and handled quickly by the college response team.
Incident Reporter Information
Full Name
*
First Name
Middle Name
Last Name
Role or Relationship to the College
*
Please Select
Student
Faculty
Staff
IT Support
Administrator
Visitor
Contractor
Other
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Incident Details
Incident Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Discovery Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident Type
*
Phishing
Malware
Unauthorized Access
Lost or Stolen Device
Account Compromise
Data Exposure
Denial of Service
Other
Brief Description of What Happened
*
Affected Assets and Impact
Affected department, lab, or unit
*
Affected system, device, or account name or identifier
Observed impact or severity
*
No impact
Minor disruption
Partial outage
Major outage
Suspected data exposure
Other
Immediate actions already taken
Response and Follow-up
Is the incident still ongoing?
*
Yes
No
Names or groups to notify or assign for follow-up
*
Additional notes or attachment reference
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