Data Breach Reporting Template
Report prepared by:
Date:
On behalf of:
1 Summary of the event and
circumstances
2 Type and amount of
personal data
3 Actions taken by recipient
when they inadvertently
received the information
4 Actions taken to retrieve
information and respond to
the breach
5 Procedures / instructions in
place to minimise risks to
security of data
6 Breach of procedure/policy
by staff member
7 Details of notication to
affected data subject
Has a complaint received
from Data Subject?
8 Details of Data Protection
training provided:
9 Procedure changes to
reduce risks of future data
loss
10 Conclusion
Data breach reporting template
Hythe Town Council
Date
Name
Organisation
When, what, who, summary of incident etc.
Title or name of the document/s; What personal information is included –
Name; Address; DoB; Bank account details; description of information about
an individual (health issues; case hearing notes/decisions etc)
Has information been retrieved? When? Has loss been contained? e.g. all
emails deleted
(communication, secure storage, sharing and exchange)
Has there been a breach of policy?
Has appropriate management action been taken?
Has the data subject been notified? If not, explain why not?
What advice given to affected data subjects?
Include date of last training prior to the incident by the staff member
breaching security
Serious/minor breach, likelihood of happening again
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