CSO/ACSO SECURITY INCIDENT REPORT

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In accordance with section 512(2) of the Industrial Security Manual (ISM), please provide the following information about the Security Incident:

Organization Name:

Organization Number:

Date:

Time:

CSO/ACSO Name:

Email Address:

Office Phone Number:

Cellular Phone Number:

Location:

1. What, where and when did the incident occur?

2. Who reported it, to whom, and when?

3. What information or asset was involved (in details)?

4. What was the security marking and description of the information or asset involved?

5. Who originated the information or asset?

6. When, for how long, and under what circumstances was the asset vulnerable to unauthorized disclosure, and to whom?

7. What actions were taken to secure the information or asset and limit the damage?

8. Is any information or asset lost or unaccounted for?

Reminder: Section 512 (3) of the ISM states:

When the results of a preliminary inquiry indicate a suspected or actual breach or compromise of information and assets, ISP is to be immediately notified by the Company Security Officer. A full report covering the preliminary inquiry and any subsequent investigative results are to be forwarded to ISP as soon as possible.