Internal form template for reporting a data security breach
- Art. 24 FADP
- Art. 33-34 GDPR
- About 10 minutes
- Italiano · Deutsch · Français · English
In brief
The internal form by which an employee reports a data security breach at once, even a suspected one. It gathers in a few pages what is needed to assess the incident without losing time.
- Who it is for
- All employees. It is kept to hand, printed or in a shared folder; it goes to whoever handles breaches.
- To decide first
- Nothing before use: the form is filled in when the incident happens (what happened, when, which data and how many people).
- Afterwards
- Put it where everyone can find it and explain in training when to use it. Every report received is noted in the breach register.
What it contains
- 1Person reporting
- 2What happened
- 3When and where
- 4Which data are affected
- 5Which and how many persons are affected
- 6What has already been done
- 7Signature
- 8Section reserved for the person receiving the report
An excerpt
1. Person reporting
| First name and surname | __________ |
| Function or department | __________ |
| Telephone and email | __________ |
| Date and time of the report | __________ |
2. What happened
Describe the event in your own words:
Type of event (more than one answer is possible):
- ☐ Data sent to the wrong recipient (email, post, message)
- ☐ Loss or theft of a device (computer, telephone, USB stick, disk)
- ☐ Loss or theft of paper documents
- ☐ Unauthorised access to an account, a system or a mailbox
- ☐ Phishing or other deception (for example password disclosed to third parties)
- ☐ Malicious software or ransomware
- ☐ Data published or shared by mistake
- ☐ Data consulted or copied without authorisation
- ☐ Unintended deletion or alteration of data
- ☐ Event at a supplier
- ☐ Other: __________
The full text is generated on the platform, with your organisation's details already in place.
Related templates
- Template for notifying data subjects of a data security breach
- Template for notifying a data security breach to the authority
- Data security breach procedure template (data breach)
Related question: Data security breach: when and how to notify the FDPIC?
A template is general information, not advice on your case: it must be adapted to your organisation. For a question on your case there is Advisorn's consulting. By Advisorn, updated on 20 October 2026.