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Incident Report Form

Date of Incident: [Date]

Incident Details:

1. Incident Description:

Describe the incident in detail, including what happened, when it occurred, and any relevant background information.

2. Incident Category:

Select the appropriate category for the incident from the following options:

  • Data Breach
  • Unauthorized Access
  • Loss or Theft of Devices
  • Malware or Virus Attack
  • Physical Security Breach
  • Other (please specify)

3. Severity Level:

Indicate the severity level of the incident:

  • Low: Minimal impact on operations and data security.
  • Medium: Moderate impact on operations and data security.
  • High: Significant impact on operations and data security.

4. Location of Incident:

Specify the location where the incident occurred, such as a physical address or network/system location.

5. Systems/Assets Affected:

List all systems, applications, and assets affected by the incident.

6. Immediate Actions Taken:

Describe any immediate actions taken to contain the incident and mitigate its impact.

7. Notification:

Indicate whether the incident has been reported to the appropriate authorities, such as regulatory bodies, law enforcement, or affected individuals.

8. Root Cause Analysis:

Provide a brief analysis of the root cause(s) of the incident, if known.

9. Follow-Up Actions:

Outline any follow-up actions required to address the incident fully, including remediation measures and preventive controls.

10. Recommendations:

Include any recommendations for improving incident response procedures or preventing similar incidents in the future.

Incident Reporting Person:

Name: [Name of Reporting Person]

Position/Role: [Reporting Person’s Position or Role]

Contact Information: [Email Address/Phone Number]

Reviewed By:

Name: [Name of Reviewer]

Position/Role: [Reviewer’s Position or Role]

Date Reviewed: [Date]

Approval Signature:



This Incident Report Form Template is designed to facilitate the reporting and documentation of security incidents, including incident details, severity level, actions taken, and follow-up measures. It provides a structured format for capturing essential information and ensuring appropriate handling of security incidents.

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