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Data Incident and Breach Report Form

Please refer to IJM UK's Personal Data Breach Procedure before completing this Personal Data Breach Form.

If you have any queries please feel free to contact Stephanie Harris at [email protected]

Data Incident and Breach Report Form

Your Details

Incident/Breach Details

To assist us with our investigation, please describe the incident/breach, providing as much information as possible. Think of who, what, when, where, why and how. If the reporting of this incident/breach has been delayed by more than 24 hours, please explain why.

Does this incident/breach involve Personal Data?

What type of personal data was included? (E.g. names, address, email address, contact details etc)

Were any of the following data types involved (if yes, tick all boxes that apply) *

× Includes any inherited or acquired data which give unique information about the physiology or the health of that individual, resulting in particular from an analysis of a biological sample from the individual in question.

Any personal data resulting from specific technical processing relating to the physical, physiological or behavioural characteristics of an individual which allows or confirms the unique identification of that individual, such as facial images, fingerprints, blood samples etc.

Includes employment rates, crime rates, poverty status, education levels, life expectancy etc.

Includes CVs, job application forms, job references, PDRs, development reviews, pension, payroll, sickness etc.

Does this incident/breach involve Commercially Sensitive Data?

E.g. Who and how many individuals does the data relate to? Do not notify the affected data subjects. The DPO or nominated deputy will determine who should be notified and how.
Provide details of any external parties that are involved or affected by the incident/breach - E.g. research partner details, suppliers, external stakeholders, commercial partners, collaborating universities etc.

Is the incident/breach ongoing?

Are you aware of or suspect any related or other data incidents/breaches in your department?

Do not notify the affected data subjects. The DPO or nominated deputy will determine who should be notified and how.
Privacy statement Any Data processed will be processed in accordance with IJM UK's Data Protection Policy. IJM UK's Data Protection Officer, Steph Harris, can be contacted at [email protected] and any requests or complaints should be made in writing to IJM UK's Data Protection Officer.

Thank you, your submission has been received.

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