Skip to site navigation

Security Incident Reporting Form

Your contact and organisational information

1.   Name ................................................

2.   Department ..........................................

3.   Organisation name ...................................

4.   Email address .......................................

5.   Telephone number ....................................


Affected machine(s) (duplicate for each host)

7.   Host name and IP address ............................

     .....................................................

8.   Time zone ...........................................

9.   Function or role of the system (e.g. mail server, desktop pc)

     .....................................................

     .....................................................

     .....................................................


Source(s) of attack if known (duplicate for each host)

10. Host name and IP address .............................

     .....................................................


11. Time zone ............................................

12. Estimated cost of handling incident ..................

     .....................................................


Description of the incident (include dates and times, 
software versions and patch levels, details of 
vulnerabilities exploited if known, methods of intrusion, 
intruder tools involved or any other relevant information)

     .....................................................

     .....................................................

     .....................................................

     .....................................................

     .....................................................

     .....................................................


Please return completed form to the UCL Computer Security
Team at cert(at)ucl.ac.uk.


FOR UCL-CERT INTERNAL USE
Time report received ...................

Tracking number assigned ...............

Please return completed form to the UCL Computer SecurityTeam at cert(at)ucl.ac.uk.

FOR UCL-CERT INTERNAL USE

Time report received ...................

Tracking number assigned ...............