ICT Incident Report Form

• Incident Numer

• Company

  Select
• Location
  Address

• Date & Time of Incident

  Date

• Reported By

Contact Information for this Incident

• Name

• Job Title

• Department

  Select ICT Cyber Security Operations Network Operations Software Development

  • ICT
  • Cyber Security Operations
  • Network Operations
  • Software Development

• Contact number

• Email address

Incident Description

• Description of incident

• Date & time of incident

  Date

• Status of incident

  Resolved

  Unresolved

  Ongoing

  Not ongoing

• Approximate number of affected systems

Details of affected system(s)

• Device Hostname

• Device Type

• Device Operating System

• Device IP Address

• Device MAC Address

Security details of affected system

• Log type

  webfilter

  antivirus

  intrusion prevention system

• Security actions

  passed

  blocked

• Number of threats

• Date & time of first indicator of compromise

  Date

• Verdict

  Select Safe Suspected compromise Compromised Infected Malware Command & Control

  • Safe
  • Suspected compromise
  • Compromised
  • Infected
  • Malware
  • Command & Control

Impact/potential impact

• Select all that apply to this incident

  Select Loss / Compromise of Data Damage to Systems System Downtime Financial Loss Other Organization's Systems Affected Integrity Damage Violation of legislation Other

  • Loss / Compromise of Data
  • Damage to Systems
  • System Downtime
  • Financial Loss
  • Other Organization's Systems Affected
  • Integrity Damage
  • Violation of legislation
  • Other

• Provide a brief description

Completion

• Observations and comments

• Name & signature of person reporting

  Sign