GDPR Data Breach Report Form

Give anyone in your organisation a fast way to flag a suspected loss or exposure of personal data. The form captures the timeline, the devices and systems involved, any witnesses and what was compromised. Designed for data protection officers, IT teams and security committees working to the 72-hour notification window.

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Date

Full name

Nombre

Apellido

Phone number

Briefly explain how the incident happened

Incident date and estimated time

Did you witness the incident yourself?

Yes No

Were there other witnesses to the incident?

Yes No

List the witnesses here

Which hardware devices were involved (tick all that apply)?

Laptop Desktop computer Mobile phone Tablet USB stick or external drive Server Printer or scanner No device involved

Select the software involved in the incident

Email system CRM or customer database Cloud storage HR system Accounting or billing software Website or CMS None

Select the type of incident involved

Unauthorised access Lost or stolen device Phishing or impersonation Malware or ransomware Accidental disclosure Deletion or loss of data Another type of incident

Has any company information been compromised?

Yes No Not sure

Have you already told your direct manager?

Yes No

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