Cyber Incident Reporting Form

CYBER INCIDENT REPORTING
Particulars and Details of Incident Name of Financial Institution:
Reporting Officer’s Name:
Reporting Officer’s Position:
Reporting Officer’s Email & Phone Number:
Date and Time of Notification:
Date and Time Incident Discovered / Detected:
Incident Level or Priority:
Type of Incident that occurred (e.g. Ransomware, Phishing, Data Breach / Leak, Insider Threat, DDoS):
Current state of incident:
Indicate Actions Taken:
Impact Assessment (examples are given but not exhaustive) Business Lines Impacted (including availability of services – Treasury Services, Cash Management, ATM, Internet / Mobile Banking, etc.):
Stakeholders Impacted:
Financial and Market Impact (trading activities, liquidity impact, transaction volumes and values etc.):
Reputational Impact:
Detailed chronological order of events Date of Incident, Start Time and Duration (DD/MM/YY) Escalation Steps Taken:
Stakeholders Informed or Involved:
Channels of Communication Involved:
Root Cause Analysis
Factors that caused the problem / reason for occurring:
Interim measures to mitigate / resolve the issue:

CYBER INCIDENT REPORTING
Final Assessment and Remediation Actions completed and pending:
Conclusion on cause and effects of incident:
Provide the Indicators of Compromise (IOCs):
List the corrective actions taken to prevent future occurrences of similar types of incident:
Estimated timelines to address the remediation of the incident (DD/MM/YY)