Data Breach Response Checklist Form
Use this form to document and track key actions and details during a suspected or confirmed data breach incident.
Date and time breach was discovered
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location or system where breach was discovered
*
Describe the data and/or systems affected
*
Immediate containment actions taken
*
Who discovered and reported the breach?
*
Who has been notified? (e.g., management, IT, legal)
*
Are third parties involved?
*
Yes
No
What evidence has been preserved?
Current status of incident
*
Please Select
Under Investigation
Contained
Resolved
Monitoring
Follow-up owner (person responsible for next actions)
*
Submit Incident Report
Should be Empty: