Forms

Use this form to report security incidents to the University Information Security Officer. If additional information is required, you will be contacted via phone or email. To assist with our initial assessment and investigation, please provide as much information as possible.

What Qualifies as an incident?

Status

Site Under Attack

Past Incident

Repeated Incidents, unresolved

Contact Information

Last Name

First Name

Title

Organization

Verify Email

Phone

Fax

Location/Site(s) Involved

Street Address Involved

City

State

Zip

Incident Description

Denial Of Service

Unauthorized Access (e.g. Intrusion/Hack)

Website Defacement

Malicious Code (e.g. virus/worm or trojan)

Threat/Harassment via electronic medium (includes employees)

Misuse of Systems (internal or external, includes inappropriate use by employees)

Other (specify)

Other incident

Date/Time of Incident Discovery

Day

Year

Month

Hour

Minute

AM/PM

Duration of Incident

How did you Detect this? (please provide as much information as possible, files, e.g. logs can be uploaded on the next item)

File upload (if you would like to send more than two files, please zip them into one file before uploading)

File Upload

Has the Incident Been resolved? Please explain.

Who else at Old Dominion has been notified about the incident? Check all that apply.

Law Enforcement ODU

Other ODU

Who else at the affected site has been notified about the incident? Check all that apply.

Law Enforcement Affected Site

Other Affected Site

Impact of Incident

Loss/Compromise of Data

System Downtime

Damage to Systems

Other Organizations' Systems Affected

Damage to the Integrity or Delivery of Critical Goods, Services or Information

Financial Loss - estimate amount $

Amount

Severity of Attack, Including Financial Loss or Infrastructure

High (e.g. Defaced websites)

Medium (e.g. Trojan detected, confirmed bot net participant)

Low (e.g. Small virus outbreak)

Unknown

Sensitivity of Data Loss or Compromise

High (e.g Privacy Act violation)

Medium (e.g. Local administration)

Low (e.g. Public materials)

Unknown

ODU IP addresses that were involved (please separate with commas)

Other Software

Steps Taken to Respond. Check all that apply.

Other Steps

Old Dominion University

Idea Fusion

Computer Incident Reporting Form