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Computer Incident Reporting Form


Use this form to report security incidents to the University Information Security Officer. If additional information is required, you will be contacted via phone or email. To assist with our initial assessment and investigation, please provide as much information as possible.

* Indicates required information

Current Status
Status:
Site Under Attack
Past Incident
Repeated Incidents, unresolved
Contact Information
If you wish to remain anonymous, enter 'anon' in the required contact fields.
Last Name *
First Name *
MI
Title
Organization
 
Email *
Verify Email *
 
Phone
Fax
 
Location/Site(s) Involved
Street Address Involved
City
State
Zip
Incident Information
Incident Description:
Denial Of Service
Unauthorized Access (e.g. Intrusion/Hack)
Website Defacement
Malicious Code (e.g. virus/worm or trojan)
Threat/Harassment via electronic medium (includes employees)
Misuse of Systems (internal or external, includes inappropriate use by employees)
Other (specify)

Date of Incident Discovery

Time

H: M: AM/PM

 

Duration of Incident
How did you Detect this?
(please provide as much information as possible, files, e.g. logs can be uploaded on the next item)

File upload
(if you would like to send more than two files, please zip them into one file before uploading)

File 1

File 2

Has the Incident Been resolved? Please explain.

Who else at Old Dominion has been notified about the incident? Check all that apply.:
System Administrator
Department Director
Human Resources
General Counsel
Law Enforcement
Other (specify)

If Law Enforcement, who & when:

Who else at the affected site has been notified about the incident? Check all that apply.:
System Administrator
Department Director
Human Resources
General Counsel
Law Enforcement
Other (specify)

If Law Enforcement, who & when:

Impact of Incident:
Loss/Compromise of Data
System Downtime
Damage to Systems
Other Organizations' Systems Affected
Damage to the Integrity or Delivery of Critical Goods, Services or Information
Financial Loss - estimate amount $
Severity of Attack, Including Financial Loss or Infrastructure:
High (e.g. Defaced websites)
Medium (e.g. Trojan detected, confirmed bot net participant)
Low (e.g. Small virus outbreak)
Unknown
Sensitivity of Data Loss or Compromise:
High (e.g Privacy Act violation)
Medium (e.g. Local administration)
Low (e.g. Public materials)
Unknown
ODU IP addresses that were involved (please separate with commas)
Computer Hardware, Operating System and any other Software Involved. Check all that apply.:
Unix
OS2
Linux
VAX/VMS
Microsoft XP/2000/NT/95/98
Novell
Sun OS/Solaris
Other Software (specify)
Steps Taken to Respond. Check all that apply.:
No Action Taken
System Disconnected From Network
Restored Data from Backup
Updated Virus Definitions & scanned hard drive
Physically Secured Computer
Log Files Examined (saved and secured)
Other (specify)