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Incident Report Form


The Incident Report Form is a critical document used to report and document security incidents or breaches promptly. This form serves as a standardized tool for capturing essential details about incidents, including their nature, severity, impact, and initial response actions. By completing this form accurately and promptly, [Your Organization Name] can ensure timely incident reporting, facilitate incident response coordination, and support post-incident analysis and remediation efforts.


Please complete this form as soon as a security incident or breach is discovered or reported. Provide detailed information about the incident to assist the Incident Response Team in assessing and responding to the situation effectively. If you are unsure about any information or require assistance, contact the Incident Response Coordinator immediately.

Incident Details:

  1. Incident Information:
    • Incident Date and Time: [Date/Time]
    • Incident Location: [Location or System Name]
    • Incident Category: [Category of Incident]
    • Incident Severity: [Low/Medium/High]
    • Incident Description: [Description of Incident]
  1. Affected Systems or Assets:
    • Systems/Assets Affected: [List of Affected Systems or Assets]
    • Description of Impact: [Description of Impact on Systems/Assets]
  1. Incident Response Actions:
    • Initial Response Actions Taken: [Actions Taken to Contain or Mitigate Incident]
    • Additional Response Actions Required: [Further Actions Needed]
  1. Incident Reporting:
    • Reporter Name: [Name of Person Reporting Incident]
    • Reporter Contact Information: [Phone Number/Email Address]
    • Reported to (Supervisor/Manager/Incident Response Coordinator): [Name/Position]

The Incident Report Form plays a crucial role in [Your Organization Name]’s incident response process, enabling timely and accurate reporting of security incidents or breaches. By completing this form thoroughly and promptly, [Your Organization Name] can facilitate effective incident response, minimize the impact of incidents, and enhance cybersecurity resilience.

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