Data Incident Response Checklist Form
Use this form to record, classify, and track the response to a data incident.
Incident Overview
Incident Title
*
Date and Time Discovered
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Reporter Name or Team
*
Incident Summary / What Was Observed
*
Impact and Classification
Incident Category
*
Unauthorized Access
Malware
Data Loss
Phishing
System Outage
Ransomware
Data Exposure
Other
Affected System/Application
*
Business Impact / Severity
*
Low
1
2
3
Critical
4
1 is Low, 4 is Critical
Response Actions and Status
Immediate actions taken
*
Current response status
*
Contained
Monitoring
Investigating
Escalated
Resolved
Follow-up owner/assignee
*
Submit
Should be Empty: