Security Incident Reporting Form
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1EDU-F01
Education Cabinet
Security Incident Reporting Form
Incident No.
Related/Associated Incident No.
Reported By:
Phone No.
Date Reported:
Agency:
Device Type:
Who Was Affected:
Location/Address of Problem:
User Description of Problem:
The below items are to be filled out by the Security Analyst only
Incident Type
(choose only one)
Web Site Defacement
Electronic
Defacement of Web Site(s)
User Compromise
Redirected Web Site(s)
Compromised/Stolen/Altered Data
Other
Theft and use of Others ID’s
Other
Denial of Service
Reconnaissance Activity
Denial of Service
Probes/Scans
Other
Unauthorized Monitoring
Other
Misuse of Resources
Malicious Code Activity
Unauthorized Use of Remote Control
Worm
Unauthorized Use of Software
Virus
Inappropriate Use of Email
Trojan Horse
Inappropriate Use of State Resources
Root Kits
Unauthorized Solicitation
Virus Scan Engine Version _____________
Illegal Log-in Attempt
DAT Version _____________
Hoaxes
Date of Last Virus Scan ___________
Storage and/or Distribution of illegal S
EPO Agent Installed
oftware
Other
Other
Internet Complaint:
Describe:
An Alert was sent to
Physical
:
EDU Security Auditors Group Contacts
Unauthorized Access
EDU Cabinet CIO’s
Access Control Avoidance
EDU Technical Contacts
Equipment Stolen or Damaged
Other:
Tornado/Storm
Fire
Floods
Incident Resolved
Bomb Threats
Incident forwarded to COT Security Services
Bio/Chemical Hazards
Other
Who Investigated it:
Evidence Collected (choose)
YES
NO
Number of Intruders:
Number of Hosts:
Incident Source:
Target:
Analysis of Findings:
Recommended Action:
Ticket Closed Date:
By:
Please send form to WFD.SECURITYSERVICES@KY.GOV
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