Security Violation Reporting Form

This form is required for all suspected or actual privacy or security breaches. Please fill out to the best of your abilities. Stared fields are mandatory. Contact ITS Helpdesk if you have further questions. 580-774-7070

Individual Providing Report*

(Full Name)

Report Date*

(Today's Date)

Incident Date*

When did the incident happen?

Type of Security Violation*

If known, select the type of security violation. If unsure, choose Other.

Select or enter value

Phone Number*

Department*

Select or enter value

Supervisor/ Manager*

Security Violation Description

Information Compromised (or at risk)

Information Systems Compromised

Hardware, software, sites etc. Please include SWOSU Tag Numbers.

Location of the Security Violation*

Please include Building & Rm Number (SWOSU onsite) or street, city, state, zip (offsite)

Other affected hosts/sites/information

Please include 3rd parties, local public health, other state agencies.

Damage or observations resulting from attack

Impact on operations to include downtime, costs, other damages

What agencies received a report of the violation?

Send me a copy of my responses

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