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Security Incident Reporting
Please provide as much information as possible regarding any security or breach incidents. Anonymous responses are acceptable.
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* Indicates required question
If known, the name of the entity associated with the incident/breach?
Which school district, BOCES, etc?
Your answer
Type of incident?
*
Check all that apply.
Loss or theft of device or media (computer, laptop, disk drive, CD, flash drive, etc)
Internal system breach
Insider wrongdoing
External system breach (e.g., hacking)
Inadvertent disclosure
Other:
Required
If known, what information was acquired/disclosed?
Your answer
Other comments or helpful information?
Your answer
Date the incident occurred?
MM
/
DD
/
YYYY
Date the incident was discovered?
MM
/
DD
/
YYYY
Your name?
Your answer
Your email?
Your answer
Your phone?
Your answer
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