Incident Report Form

Loss, theft or unauthorised access to personal or sensitive information

·  This form is an attachment to the RMIT Procedure for Portable Storage Device (PSD) Use and Security

·  If personal information or information sensitive to RMIT operations stored within a portage storage device has been lost, stolen or accessed by an unauthorised person, this form should be completed and provided to your manager or supervisor.

·  If personal information was involved, a copy of this form should be forwarded to the RMIT Privacy Officer.

Has the report been provided to: / Responsible Manager / Supervisor (please tick one box) / No / Yes
Name of responsible manager:
RMIT Privacy Officer (required if personal information involved) / No / Yes
1.  / Name of staff member making the report:
Organisational Unit:
Contact details: / Ph: / Email: / Date:
2. / Has the device been lost or stolen? / Tick one: / Lost? / Go to section 3
Stolen? / Go to section 4
3. / If the device has been lost, please answer the following questions, then go to section 5:
Where and when did you last have the device?
Have you made a thorough search of all likely locations?
4. / If the device has been stolen, please answer the following questions, then go to section 5:
From where, when and how was it taken?
Do you know who may have taken it and/or why?
Have you reported the theft to security or the police?
5. / What type of information was contained on the device: / Tick one: / Personal information
Information sensitive to RMIT operations
6. / Please detail the information and outline possible consequences of this loss:
Information detail / Possible consequences of the loss of this file
7. / Detail below all missing records containing personal RMIT information and the nature of that information:
Name of file / Number of personal records / Details of personal information
(e.g. name; ID number) / Is there a copy elsewhere?
Yes/No
8. / Outline any particular consequences of this loss that are of major concern:
(e.g. is there personal RMIT information that, in the wrong hands, could cause problems for the individuals concerned? Is there any information about student grades that is irretrievable?)

Document: PSD_Loss_form.doc

Author: Kathy Bramwell

Save Date: 18/10/2010

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