Cybersecurity Incident Reporting

Namerequired

First Name

Last Name

Email Addressrequired

District Phone Numberrequired

Phone number/extension assigned to this staff member. Not all staff members will have an extension.

Mobile/Home/Alt Phone Numberrequired

This number will be used if we need more information quickly in the event of an emergency situation.

Job titlerequired

Choose from list. If title not found, choose "None of These" at the bottom of the list.

What was your location when the incident was discovered?required

In which room is the problem device located?required

Room number and/or description.

Please identify the specific devicerequired

Enter the Serial Number, Asset Tag Number, Computer/iPad Name or IP Address

Who owns the device?required

Please select all that apply.

This incident may have been due to . . .requiredPlease consider any recent activity with the device when symptoms appeared.

An attack executed from removable media (e.g., flash drive, CD) or a peripheral device

An attack executed via an email message or attachment (e.g. malware infection)

An attack executed from a website or a web-based application (e.g. drive-by download)

An continuous attack from a source that employs brute force methods to compromise or destroy systems, networks, or services

A violation of the district's acceptable usage policies by an authorized user

The loss or theft of a computing device or media used by the organization, such as a laptop or smartphone

I have no idea and do not want to speculate

Please consider any recent activity with the device when symptoms appeared.

If visiting a web site may have caused this incident to occur, if known, what is the web address (URL) of the site that was visited?

Has the device been disconnected from the network?required

If not, PLEASE REMOVE NETWORK CABLE and/or SHUT OFF Wi-Fi. DO NOT TURN OFF THE DEVICE! CALL TECH!

Do you believe this incident may have resulted in a data breach, or unauthorized access to data?required

If a data breach, based on the level of access granted to my user account(s), the affected information most likelybelongs to the following category:requiredPlease select one.

Security number, date and place of birth, mother’s maiden name) or linked records (e.g., medical, educational, financial and employment)

Confidential Information - very important and highly sensitive material that is not classified as PII. (e.g.,IEP/504, personnel information, key financial information, system access passwords)

Internal Information - intended for unrestricted use within the district (e.g., personnel directories,internal policies and procedures, internal e-mail messages)

Directory Information - information generally not considered harmful if disclosed without the consent ofa parent (e.g., student name, parents’ names, grade level, enrollment status, identification number, user idfor electronic system access)

Public Information - specifically approved for public release by a designated authority within the district(e.g., marketing brochures and material posted to the district’s website, social media or mobile app)

This Incident Was Not A Data Breach - no information was seemingly accessed by an intruder.

Please select one.

Incident Summaryrequired0 / 1000

Describe the symptoms of the incident, including date/time discovered, and what you were doing.

Incident Mitigationrequired0 / 1000

Please describe actions you've taken to understand and resolve the problem you've experienced.

Additional Comments / Notes

Please provide any other information you think may be relevant as to determining a possible cause of

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