Security Incident Report Form

Please provide as many details as possible. This information is crucial to the expedited investigation of the incident.

Please tell us your name. Anonymous reports will be investigated to the best of our ability.
Please use a valid e-mail address to allow us to contact you if additional information is required.
Not required, you may provide your phone number to facilitate follow-up communication.
If you do not know a specific date, please estimate to the best of your ability.
If you do not know a specific time, please estimate to the best of your ability.
What types of systems were affected? *
Select all that apply
University managed servers
Ethernet, modems, internet
University managed device
Incidents of defacement or suspected tampering
Not for technical support - contact ITAC
Not for technical support - call ITAC
Not for phishing - forward phishing emails as attachments to
Specify service(s) in Details section
Please note services here - add more in Details section if necessary
Use as much detail as possible to fully describe the incident.
Please describe the location where the incident occurred and/or what was discovered.
Include details like IP and MAC addresses, tag numbers, web links, anything that could be helpful.
Is the computing resource still connected to the network?
Use if reporting on a device or server connected to the university network.

State law requires that you be informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you. Please visit our Privacy Statement for more information that is collected through these forms and through this site.