Stephen F. Austin State University

Individual Security Incident Report Form

Information Technology Services

STATUS

Site Under Attack
Past Incident
Repeated Incidents, unresolved

Contact Information

Name
Title	Department	Location
Email	Phone

If not on SFA Campus / Nacogdoches:

Street Address

City

State

Zip code

Additional Contact Information

Incident Description / Type

Denial of Service
Unauthorized Electronic Monitoring (i.e. Sniffers)
Distributed Denial of Service
Misuse of Systems (Internal or External)
Malicious code (virus, worm)
Website Defacement
Intrusion/Hack/Probe/Scan
Other
Explain

Server Type Affected

Critical Production Application
Critical Administrative/Support Application
Email Servers
Research Applications/Data
Academic Applications/Data
Web Servers (external)
Web Servers (internal)
FTP
Print Servers
Other

If other, explain:

Server / Workstation Information (if known)

IP Address

Server / Workstation Name

Operating System

MAC Address

User ID Used During Attack

Desktop
Laptop

Additional Information

Date / Time of Outage Discovery

Date of Discovery

Time of Discovery

Duration of Attack

Date / Time of Outage Remediation

Date of Remediation

Time of Remediation

Remediation Man-Hours

Total Individuals Involved in Remediation

Outage Misc. Information

Impact of Outage

Loss/Compromise of Data
System Downtime
Damage to Systems
Financial Loss
Estimated Loss $
Damage to the Integrity or Delivery of Critical Goods, Services or Information
Other Organizations' Systems Affected

Severity of Attack, Including Financial Loss, Infrastructure, PR Impact if made public

High
Medium
Low
Unknown

Sensitivity of Data

High
Medium
Low
Unknown

How did you detect this?

Was a disaster recovery plan initiated? Explain.

Was law enforcement contacted on this? Who & when?

Has the incident been resolved?

Yes
No

Explain

What preventive measures have taken place so the incident will not re-occur?

Additional Information

Privacy and Security Policy