subject_line
West Islip Union Free School District
Data Incident Report
First Name:
*
Last Name:
*
School/Building
*
Bayview
Beach Street
District Office
Kirdahy
Manetuck
Oquenock
Paul J. Bellew
Transportation
Udall
Westbrook
WIHS
Date of incident:
*
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Description of Incident:
*
Loss.or Theft of Media (laptop, hard drive, flash drive)
Internal Breach (internal wrong doing)
External Breach (Hack)
Unauthorized Access to Data
Virus/Malware
Other
Other
What Information was compromised (check all that apply)
*
Student Name
Student Social Security Number
Student NYSIS ID
Student Grades
Teacher/Principal APPR Data
Other Personally Identifiable Data
Other sensitive or confidential data
Was this already reported?
*
Yes
No
To whom was this reported?
Please describe the incident:
*
Please sign your name below:
*
clear
Today's Date:
*
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