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Cyber Incident Report

To protect your information, an E-Alert application must be completed in under 30 minutes The form will be cleared automatically after this duration has passed.
* indicates required fields

General Information *

Time Reported
: 
*
Creator Email

General Info *
Any information not known, please use TBD in the form. Do NOT spend more than 5 minutes completing this form. The narrative box at the very bottom is part of the default template, and not in use.
Is the Date/Time of the initial compromise known? (When did this first start?)
Date and Time Incident Discovered? (When did you first become aware of the problem?) *
Reporting Party
Name *
Department/Faculty *
Title/Role *
Email *

Incident Details *
Incident Details
General Incident Type|Description (i.e. website compromise, email fraud) *
Ransomware
Confidence Level *
Specific Incident Type | Description (choose best fit category) *

Host and User Impacts *
Host and User Impacts
Specific location of systems (e.g., lab, office) *
Number of systems affected *
System Name(s) | ID tag (If more than one seperate with a comma) *
Device IP(s) (If more than one seperate with comma) *
Type of System (select all applicable) *
Involved Asset(s), select highest level (Severity Assessment) *
User Impact
Number of users affected *
Involved User(s), select the highest (Severity Assessment) *
List of User IDs or Emails (seperate by comma if more than one) *
Data Impact
Type of data involved (Check any that apply) *
Data Classification Level (if known)
Quantity of data involved (e.g., number of files, databases) *

Additional Details *
Additional Details if known
Patient "Zero" Identified
Observations and Impact - short narrative what you observed, how you discovered the incident , and what the current business impact is
IOCs collected (IPs, Hashes, Suspicious Usernames, etc.) seperate by comma
Containment and Remediation actions taken
Containment *
Remediation

Narrative

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