Credential Harvesting Incident Report Form
Use this form to report a suspected credential harvesting incident and share the key details needed for review and response.
Incident Reporter Information
Reporter’s Name
*
First Name
Last Name
Job Title / Role
*
Organization or Department
*
Contact Email or Phone Number
*
Incident Details
Date and time incident was noticed or occurred
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident location or channel
*
Email
Text message
Phone call
Website
Social media
Other
Affected account, service, or system
*
Incident summary or description
Credential Exposure and Response
Was any login credential entered or possibly compromised?
*
Yes
No
Unsure
What indicators were observed?
Suspicious link
Fake login page
Urgent request
Spoofed sender
Unexpected attachment
Other
What actions have already been taken?
Changed password
Reported to IT/Security
Revoked access
Enabled MFA
Contacted users
No action yet
Other
Upload screenshots or related evidence
Upload a File
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