Personal Data Breach Notification

Please provide as much information as possible. If you do not know the answer, or you are waiting on completion of an internal investigation, please state this. In the wake of a personal data breach, swift containment and recovery of the situation is vital. Every effort should be taken to minimise the potential impact on affected individuals, and details of the steps taken to achieve this should be included in this form. What is Personal Data: Personal Data (also known as personal information) is defined by the following: • Personal data includes any information relating to an identified or identifiable natural person – put simply, this includes data which either by itself or with other data held by, or available to CSSC, that can be used to identify you. • Personal data also includes special or sensitive categories of personal data. Personal data may include but is not limited to the following: • Full name, date of birth, CSSC Number, postal address, email address, employer/business, professional information, job titles, next of kin and dietary requirements or national, regional or area conference, telephone number • Bank and card details • Any other personal data which is voluntarily provided to CSSC from time to time.

Details of the data protection breach

Name*

Email Address*

Todays Date*

Time of Breach:*

Describe the incident in as much detail as possible.*

When did the incident happen?*

How did the incident happen?*

What measures have been put in place to prevent an incident of this nature occurring?*

What policies, procedures or agreements are considered relevant to this incident?*

Personal data placed at risk

What personal data has been placed at risk - Please specify if any financial or sensitive personal data has been affected and provide details below.*

How many individuals have been affected?*

Are the affected individuals aware that the incident has occurred? Yes / No*

What are the potential consequences and adverse effects on those individuals / personnel?*

Containment and recovery

What action has been taken to minimise/mitigate the effect on the affected individuals? Please provide details.*

Has the data placed at risk been recovered? If so, please provide details of how and when this occurred.*

What steps have been taken to prevent a recurrence of this incident?*

Miscellaneous

Do we need to notify any 3rd Parties (overseas), third parties of the data protection authorities about this incident? If yes, please provide details*

Has there been any media coverage of the incident? If so, please provide details of this.*

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