Report a Security Incident/Compromise – SelfDesign Support Request

Purpose

Use this form to report any suspected or confirmed security events or incidents involving SelfDesign systems, data, devices, or facilities. This includes suspicious activity, unauthorized access, data exposure, lost or stolen devices, or any situation that may impact information security or privacy.

Submission Recipient

IT Department

Name *

First

Last

Email *

Phone

Security Incident Title *

Description of the Event / Incident *

Team Lead *

Do you know when the incident was discovered?

Date

Time

Do you know when the incident occurred?

Date

Time

Number of individuals affected

Types of Users involved *

Does the incident involve Personal Information? *

Yes
No
Unknown

What type of information may be involved? *

Estimated Sensitivity of the Security Incident

Low
Medium
High

Have any immediate actions been taken to contain the issue? *

Yes
No

Described Containment Actions *

Please describe the actions that were taken

This submission will be received by the IT Department