Reporting Tool
Privacy Breach Management Tools

Privacy Breach Summary Report for Fiscal Year 20XX—XX	
Branch	Breach
Date	Date Reported	Context	Material Breached	Risk Impact	Containment Action 	Recommended Remedial Action 	Status	
First Quarter (April 1 to June 30)	

Second Quarter (July 1 to September 30)	

Third Quarter (October 1 to December 31)	

Fourth Quarter (January 1 to March 31)	

Branch: Unit, directorate, etc. 
Context: Background
Material breached: Electronic, hard copy, contents
Status: Remedial action completed; breach closed

Note: This document should not include any personal information or identifiers.