IG Case Details
Copyright(C) 1993-2026 House-on-the-Hill Software Ltd.

****CONFIDENTIAL****

INFORMATION SECURITY INCIDENT REPORT

An information security incident is any situation involving personal or sensitive information where it:

• is accessed, used, disclosed, modified or destroyed in an unauthorised manner.

• is placed outside of the normal organisational controls (increasing the risk of unauthorised access or use).

• cannot be accounted for by those who have a duty of custody for that information.

Incident Details

This form must be completed by member of staff who has in-depth knowledge of this incident as soon as possible

after the incident has been discovered. It must be completed in one sessions as once submitted it can not be resumed.

Details of the person reporting the incident:
(IG) Reported by:*
(IG) Rep By Job Title:*
(IG) Reported by E-Mail:*
(IG) Reported by Tele. Number:*
(IG) Team Name:*
(IG) Department:*
Details of the member (s) of staff responsible for the incident (name (s), position (s) etc).
(IG) #1 Member of staff involved: (IG) #1 Job Title: (IG) #1 Team & Location:* If incident is not a SCC incident please add ‘Non SCC’ (IG) #1 Department:*
(IG) #2 Member of staff involved: (IG) #2 Job Title: (IG) #2 Team & Location: If incident is not a SCC incident please add ‘Non SCC’ (IG) #2 Department:
(IG) #3 Member of staff involved: (IG) #3 Job Title: (IG) #3 Team & Location: If incident is not a SCC incident please add ‘Non SCC’ (IG) #3 Department:
(IG) Other Staff Members:
(IG) Name of Data Subject(s) affected by this breach:
(IG) Date of Incident:
(IG) Date Service Area made aware of Incident:*
(IG) How was the incident discovered and by who?:*
(IG) What information does this concern:* E.g. a report about, minutes of meeting etc
(IG) Description of Incident:*
(IG) What format was the information in?:*
If electronic, was the information held on an encrypted device/password protected or protected in another way? Describe the security measures in place.
(IG) Security Measures for Electronic Data:
Describe in detail what has happened. Include why you think this has happened and who had responsibility for any information compromised or lost.
(IG) What has happened:*
How many people does the information refer to and who are they (i.e. service user, employee etc).
(IG) How many and who:*
Have you notified the individuals that the information refers to, of the breach? If so, please provide as much detail as possible. Please include if a complaint been made?
(IG) Notification Information:*
Have you been able to recover the information? If not where do you think the information is?
(IG) Recovery:*
Please detail here any other information you think IGU should be made aware of in relation to this case. If the data relates to financial assessments or blue badges please include whether any of the breached information was derived from DWP Searchlight
(IG) Other Information:
Further guidance on completing this form can be obtained from the Information Governance

Team at infogov@staffordshire.gov.uk or within the Information Security Incident Guidance.