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Data Breach Report
Please fill in this form if you SUSPECT a breach of data controlled by OCA has occurred.
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Email Address
In order for us to follow up this report with further questions, please provide your Email address here. (not essential)
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Date of Breach
MM
/
DD
/
YYYY
Time of Breach (if known)
Time
:
AM
PM
Location of the breach
*
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Nature of the breach
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Number of affected individuals
*
Approx. number of affected individuals
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Type of Data at Risk
*
Non-Personal
Personal
Sensitive
Financial
Medical
Other:
Immediate Action Taken
*
Please describe any immediate actions taken to reduce the impact of this data breach, by yourself or any others. Check before submitting this form.
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Crime Reference Number (if applicable)
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