Security Incident Report

Please include as much information as possible. If you have any questions, please contact IT Security at security@csun.edu or call (818) 677-6100.

You may leave items blank if it does not apply to you, or if the information is redundant. Please verify your contact information and be sure to include as much information as possible about the incident itself.

1. Reporter Information:

Name: *

E-mail: *

Primary Phone: *

Department Name: *

Ext: *

Mail Drop:

Secondary Phone:

2. Incident Information

Date Incident Discovered:

Month

Day

Year

Select the date that you discovered the incident.

Incident Date:

Month

Day

Year

Select the date of the incident.

Incident Time:

Hour

Minute

Select the time of the incident.

Priority:

Type of Incident:

Target System (The IP address and hostname of the machine on which the security incident occurred):

Target OS (The operating system, including service pack number, of the machine that the security incident took place on):

One Line Incident Summary:

3. Description of Incident:

Describe the incident as best you can. Explain how it was first identified, how it was determined to be an incident, what happened that may have led up to the incident, etc. Include anything else that you think is relevant to the incident.

Enter Description Here:

4. Indicate the Number of Estimated Records:

Volume of pages or files involved in the incident
Number of individuals involved in the incident

Enter estimated records info here:

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Security Incident Report

1. Reporter Information:

2. Incident Information

3. Description of Incident:

4. Indicate the Number of Estimated Records:

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