Data Protection Incident Report

Please fill out this form as soon as possible.
If you are unable to answer all the questions, complete only those for which you have information.
The responses in this form will be sent to the management and the data protection officer.

Name of the reporting person

Detailed description of the data protection incident

Who identified the data protection incident (you, colleagues, data subjects, third parties, etc.)? Please provide contact details if applicable.

Time period or specific time of the incident

Time of becoming aware of the incident

Cause of the incident (if already known)

Location of the incident / affected systems and data

How many individuals’ data are affected?

Have any countermeasures already been taken? If yes, which ones?