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Security Incident Report

Please include as much information as possible. If you have any questions, please contact IT Security at or call (818) 677-6100.

You may leave items blank if it does not apply to you, or if the information is redundant. Please verify your contact information and be sure to include as much information as possible about the incident itself. 

1. Reporter Information:

2. Incident Information

Select the date that you discovered the incident.
Select the date of the incident.
Select the time of the incident.

3. Description of Incident:

Describe the incident as best you can. Explain how it was first identified, how it was determined to be an incident, what happened that may have led up to the incident, etc. Include anything else that you think is relevant to the incident.

4. Indicate the Number of Estimated Records:

  • Volume of pages or files involved in the incident
  • Number of individuals involved in the incident 
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