Computer Security Incident Report

All fields marked with bold are required.

   
   
   
   
   
   
Name & Contact of Reporting Party
(xxx-xxx-xxxx format)

(xxx-xxx-xxxx format)

Name & Contact of User (Student, faculty, staff, etc. if different from above)
(xxx-xxx-xxxx format)

(xxx-xxx-xxxx format)

Incident Details
  mm/dd/yy
(hh:mm AM/PM format)

Type of attack (Check all that apply):
   
   
   
   
   
   
   
   
Available Logs
   
   
(If possible burn all logs to a CD or best offline storage to be kept for further review if needed)

   
   
(If possible burn all logs to a CD or best offline storage to be kept for further review if needed)

   
   
(If possible burn all logs to a CD or best offline storage to be kept for further review if needed)

Impact of Attack to User, Network or Department
   
   
   
   
   
Dollar Amount of Loss Due To Damage
(amount in US dollars)

   
   
   
   
   
Source of Incident (if known)
Location of Compromised Machine
Description of Compromised Machine