Data Breach Incident Report Form
When a data breach occurs, fast and thorough documentation is critical for compliance and response. This multi-page incident report form guides reporters through the essential information needed: breach discovery timeline, affected systems and data types, scope assessment, immediate response actions, and notification requirements. Designed to meet GDPR 72-hour notification requirements and other regulatory frameworks, it ensures no critical detail is missed during high-pressure incident response.
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export function dataBreachReport(form: FormTs) {
// Data Breach Incident Report Form
// Demonstrates: Pages (multi-page wizard), Datepicker, Timepicker, MatrixQuestion, Slider, Integer, conditional flows
// ============================================
// HEADER - Critical Alert Style
// ============================================
form.addRow(row => {
row.addTextPanel('header', {
label: 'Data Breach Incident Report',
computedValue: () => 'CRITICAL: Document all details immediately. Time-sensitive for compliance.',
customStyles: {
backgroundColor: '#dc2626',
color: 'white',
padding: '24px',
borderRadius: '12px',
textAlign: 'center'
}
});
});
// ============================================
// MULTI-PAGE WIZARD
// ============================================
const pages = form.addPages('incidentPages', { heightMode: 'current-page' });
// ==========================================
// PAGE 1: Discovery & Timeline
// ==========================================
const page1 = pages.addPage('discovery');
page1.setTitle(() => 'Step 1: Discovery & Timeline');
const discoverySection = page1.addSubform('discoverySection', {
title: 'When Was the Breach Discovered?',
customStyles: { backgroundColor: '#fef2f2', padding: '20px', borderRadius: '10px' }
});
discoverySection.addRow(row => {
row.addDatepicker('discoveryDate', {
label: 'Date Breach Was Discovered',
isRequired: true
}, '1fr');
row.addTimepicker('discoveryTime', {
label: 'Approximate Time',
isRequired: true
}, '1fr');
});
discoverySection.addRow(row => {
row.addDropdown('discoveryMethod', {
label: 'How Was the Breach Discovered?',
options: [
{ id: 'monitoring', name: 'Security Monitoring/Alerts' },
{ id: 'employee', name: 'Employee Report' },
{ id: 'customer', name: 'Customer Complaint' },
{ id: 'third-party', name: 'Third Party Notification' },
{ id: 'audit', name: 'Audit/Review' },
{ id: 'law-enforcement', name: 'Law Enforcement Notification' },
{ id: 'media', name: 'Media Report' },
{ id: 'other', name: 'Other' }
],
isRequired: true
});
});
const reporterSection = page1.addSubform('reporterSection', {
title: 'Reporter Information'
});
reporterSection.addRow(row => {
row.addTextbox('reporterName', {
label: 'Your Name',
isRequired: true
}, '1fr');
row.addDropdown('reporterRole', {
label: 'Your Role',
options: [
{ id: 'it-security', name: 'IT/Security Staff' },
{ id: 'dpo', name: 'Data Protection Officer' },
{ id: 'management', name: 'Management' },
{ id: 'employee', name: 'Employee' },
{ id: 'contractor', name: 'Contractor/Vendor' },
{ id: 'other', name: 'Other' }
],
isRequired: true
}, '1fr');
});
reporterSection.addRow(row => {
row.addEmail('reporterEmail', {
label: 'Contact Email',
isRequired: true
}, '1fr');
row.addTextbox('reporterPhone', {
label: 'Contact Phone',
placeholder: '+1 (555) 123-4567'
}, '1fr');
});
// ==========================================
// PAGE 2: Incident Details
// ==========================================
const page2 = pages.addPage('details');
page2.setTitle(() => 'Step 2: Incident Details');
const incidentTypeSection = page2.addSubform('incidentTypeSection', {
title: 'Type of Incident',
customStyles: { backgroundColor: '#fff7ed', padding: '20px', borderRadius: '10px' }
});
incidentTypeSection.addRow(row => {
row.addDropdown('breachType', {
label: 'Primary Breach Type',
options: [
{ id: 'hacking', name: 'Hacking/Cyber Attack' },
{ id: 'malware', name: 'Malware/Ransomware' },
{ id: 'phishing', name: 'Phishing Attack' },
{ id: 'unauthorized-access', name: 'Unauthorized Access' },
{ id: 'lost-device', name: 'Lost/Stolen Device' },
{ id: 'misdirected-email', name: 'Misdirected Email/Fax' },
{ id: 'improper-disposal', name: 'Improper Disposal' },
{ id: 'insider-threat', name: 'Insider Threat' },
{ id: 'vendor-breach', name: 'Third-Party/Vendor Breach' },
{ id: 'physical', name: 'Physical Break-in' },
{ id: 'unknown', name: 'Unknown/Under Investigation' }
],
isRequired: true
});
});
incidentTypeSection.addRow(row => {
row.addRadioButton('intentional', {
label: 'Was this breach intentional or accidental?',
options: [
{ id: 'intentional', name: 'Intentional (malicious)' },
{ id: 'accidental', name: 'Accidental' },
{ id: 'unknown', name: 'Unknown at this time' }
],
orientation: 'horizontal',
isRequired: true
});
});
const descriptionSection = page2.addSubform('descriptionSection', {
title: 'Incident Description'
});
descriptionSection.addRow(row => {
row.addTextarea('incidentDescription', {
label: 'Describe what happened:',
placeholder: 'Provide a detailed description of the incident, how it was discovered, and any known details about how the breach occurred...',
rows: 5,
autoExpand: true,
isRequired: true
});
});
// ==========================================
// PAGE 3: Affected Data & Systems
// ==========================================
const page3 = pages.addPage('scope');
page3.setTitle(() => 'Step 3: Affected Data & Scope');
const dataTypesSection = page3.addSubform('dataTypesSection', {
title: 'Types of Data Affected',
customStyles: { backgroundColor: '#fef3c7', padding: '20px', borderRadius: '10px' }
});
dataTypesSection.addRow(row => {
row.addMatrixQuestion('dataMatrix', {
label: 'What types of data were potentially exposed?',
rows: [
{ id: 'names', label: 'Names', description: 'Full names of individuals', isRequired: false },
{ id: 'contact', label: 'Contact Information', description: 'Email, phone, address', isRequired: false },
{ id: 'financial', label: 'Financial Data', description: 'Bank accounts, credit cards', isRequired: false },
{ id: 'health', label: 'Health Information', description: 'Medical records, health data', isRequired: false },
{ id: 'ssn', label: 'Government IDs', description: 'SSN, passport, driver license', isRequired: false },
{ id: 'credentials', label: 'Login Credentials', description: 'Usernames, passwords', isRequired: false },
{ id: 'proprietary', label: 'Proprietary Data', description: 'Trade secrets, IP', isRequired: false }
],
columns: [
{ id: 'not-affected', label: 'Not Affected' },
{ id: 'possibly', label: 'Possibly' },
{ id: 'confirmed', label: 'Confirmed' }
],
striped: true,
fullWidth: true
});
});
const scopeSection = page3.addSubform('scopeSection', {
title: 'Scope Assessment'
});
scopeSection.addRow(row => {
row.addInteger('estimatedRecords', {
label: 'Estimated Number of Records Affected',
min: 0,
placeholder: 'Enter estimated count (or 0 if unknown)',
isRequired: true
}, '1fr');
row.addDropdown('recordConfidence', {
label: 'Confidence Level in Estimate',
options: [
{ id: 'confirmed', name: 'Confirmed/Exact' },
{ id: 'high', name: 'High Confidence' },
{ id: 'medium', name: 'Medium Confidence' },
{ id: 'low', name: 'Low Confidence/Best Guess' },
{ id: 'unknown', name: 'Unknown - Investigation Ongoing' }
],
isRequired: true
}, '1fr');
});
scopeSection.addRow(row => {
row.addCheckboxList('systemsAffected', {
label: 'Which systems were affected?',
options: [
{ id: 'database', name: 'Database Server' },
{ id: 'web-server', name: 'Web Server' },
{ id: 'email', name: 'Email System' },
{ id: 'file-storage', name: 'File Storage/Cloud' },
{ id: 'crm', name: 'CRM System' },
{ id: 'hr-system', name: 'HR/Payroll System' },
{ id: 'backup', name: 'Backup Systems' },
{ id: 'endpoint', name: 'Employee Devices' },
{ id: 'third-party', name: 'Third-Party Service' },
{ id: 'physical', name: 'Physical Records' }
],
orientation: 'vertical'
});
});
// ==========================================
// PAGE 4: Severity & Response
// ==========================================
const page4 = pages.addPage('response');
page4.setTitle(() => 'Step 4: Severity & Response');
const severitySection = page4.addSubform('severitySection', {
title: 'Severity Assessment',
customStyles: () => {
const severity = severitySection.slider('severityLevel')?.value();
if (severity !== null && severity !== undefined) {
if (severity >= 8) return { backgroundColor: '#fee2e2', padding: '20px', borderRadius: '10px' };
if (severity >= 5) return { backgroundColor: '#fef3c7', padding: '20px', borderRadius: '10px' };
return { backgroundColor: '#d1fae5', padding: '20px', borderRadius: '10px' };
}
return { backgroundColor: '#f8fafc', padding: '20px', borderRadius: '10px' };
}
});
severitySection.addRow(row => {
row.addSlider('severityLevel', {
label: () => {
const severity = severitySection.slider('severityLevel')?.value();
if (severity !== null && severity !== undefined) {
if (severity >= 8) return 'Severity Level: CRITICAL';
if (severity >= 5) return 'Severity Level: HIGH';
if (severity >= 3) return 'Severity Level: MEDIUM';
return 'Severity Level: LOW';
}
return 'Severity Level (1-10)';
},
min: 1,
max: 10,
step: 1,
showValue: true,
defaultValue: 5
});
});
severitySection.addRow(row => {
row.addCheckboxList('riskFactors', {
label: 'Risk Factors Present (select all that apply):',
options: [
{ id: 'sensitive-data', name: 'Highly sensitive personal data involved' },
{ id: 'large-scale', name: 'Large number of individuals affected' },
{ id: 'high-risk-group', name: 'Vulnerable individuals affected (children, patients)' },
{ id: 'no-encryption', name: 'Data was not encrypted' },
{ id: 'ongoing', name: 'Breach may still be ongoing' },
{ id: 'malicious', name: 'Confirmed malicious intent' },
{ id: 'public', name: 'Data may be public or sold' },
{ id: 'regulatory', name: 'Regulatory notification required' }
],
orientation: 'vertical'
});
});
const responseSection = page4.addSubform('responseSection', {
title: 'Immediate Response Actions'
});
responseSection.addRow(row => {
row.addCheckboxList('actionsTaken', {
label: 'Actions Already Taken:',
options: [
{ id: 'contained', name: 'Breach has been contained' },
{ id: 'systems-secured', name: 'Affected systems secured/isolated' },
{ id: 'passwords-reset', name: 'Passwords reset' },
{ id: 'evidence-preserved', name: 'Evidence preserved for investigation' },
{ id: 'it-notified', name: 'IT/Security team notified' },
{ id: 'management-notified', name: 'Management notified' },
{ id: 'dpo-notified', name: 'Data Protection Officer notified' },
{ id: 'legal-notified', name: 'Legal counsel engaged' }
],
orientation: 'vertical'
});
});
responseSection.addSpacer({ height: '15px' });
responseSection.addRow(row => {
row.addTextarea('nextSteps', {
label: 'Planned Next Steps:',
placeholder: 'Describe the immediate next steps planned for investigation and remediation...',
rows: 4,
autoExpand: true
});
});
// ============================================
// SUMMARY SECTION (after pages)
// ============================================
const summarySection = form.addSubform('summarySection', {
title: 'Incident Report Summary',
isVisible: () => {
const severity = severitySection.slider('severityLevel')?.value();
return severity !== null && severity !== undefined;
}
});
summarySection.addRow(row => {
row.addTextPanel('summaryContent', {
computedValue: () => {
const discoveryDate = discoverySection.datepicker('discoveryDate')?.value();
const breachType = incidentTypeSection.dropdown('breachType')?.value();
const estimatedRecords = scopeSection.integer('estimatedRecords')?.value();
const severity = severitySection.slider('severityLevel')?.value();
const actions = responseSection.checkboxList('actionsTaken')?.value() || [];
if (!severity) return '';
const breachTypeLabels: Record<string, string> = {
'hacking': 'Cyber Attack', 'malware': 'Malware/Ransomware', 'phishing': 'Phishing',
'unauthorized-access': 'Unauthorized Access', 'lost-device': 'Lost Device',
'misdirected-email': 'Misdirected Email', 'improper-disposal': 'Improper Disposal',
'insider-threat': 'Insider Threat', 'vendor-breach': 'Vendor Breach',
'physical': 'Physical Break-in', 'unknown': 'Under Investigation'
};
let severityEmoji = '🔴';
let severityText = 'CRITICAL';
if (severity < 8) { severityEmoji = '🟠'; severityText = 'HIGH'; }
if (severity < 5) { severityEmoji = '🟡'; severityText = 'MEDIUM'; }
if (severity < 3) { severityEmoji = '🟢'; severityText = 'LOW'; }
let summary = `${severityEmoji} DATA BREACH INCIDENT REPORT\n`;
summary += `${'═'.repeat(35)}\n\n`;
summary += `⚠️ Severity: ${severityText} (${severity}/10)\n\n`;
if (discoveryDate) summary += `📅 Discovered: ${discoveryDate}\n`;
if (breachType) summary += `🔓 Type: ${breachTypeLabels[breachType] || breachType}\n`;
if (estimatedRecords !== null && estimatedRecords !== undefined) {
summary += `📊 Est. Records: ${estimatedRecords.toLocaleString()}\n`;
}
summary += `\n✅ Actions Taken: ${actions.length} items\n`;
const containedAction = actions.includes('contained');
summary += `\n${containedAction ? '🔒 Breach CONTAINED' : '⚠️ Breach may be ONGOING'}`;
return summary;
},
customStyles: () => {
const severity = severitySection.slider('severityLevel')?.value() ?? 5;
const baseStyles = {
padding: '20px',
borderRadius: '10px',
whiteSpace: 'pre-wrap',
fontFamily: 'monospace',
fontSize: '14px'
};
if (severity >= 8) {
return { ...baseStyles, backgroundColor: '#fee2e2', borderLeft: '4px solid #dc2626' };
} else if (severity >= 5) {
return { ...baseStyles, backgroundColor: '#fef3c7', borderLeft: '4px solid #f59e0b' };
}
return { ...baseStyles, backgroundColor: '#d1fae5', borderLeft: '4px solid #059669' };
}
});
});
// ============================================
// FORM CONFIGURATION
// ============================================
form.configureSubmitButton({
label: () => {
const severity = severitySection.slider('severityLevel')?.value() ?? 5;
if (severity >= 8) return 'Submit CRITICAL Incident Report';
return 'Submit Incident Report';
},
isVisible: () => {
const severity = severitySection.slider('severityLevel')?.value();
return severity !== null && severity !== undefined;
}
});
form.configureCompletionScreen({
type: 'text',
title: 'Incident Report Submitted',
message: 'Your report has been logged and the appropriate teams have been notified. Please remain available for follow-up questions. Remember: under GDPR, reportable breaches must be notified to authorities within 72 hours of discovery.'
});
}
Frequently Asked Questions
How quickly must a data breach be reported?
Under GDPR, reportable breaches must be notified to authorities within 72 hours of discovery. This form helps document incidents quickly to meet tight deadlines. Internal reporting should happen even faster - ideally within hours.
What qualifies as a data breach?
A data breach is any security incident that leads to accidental or unlawful destruction, loss, alteration, unauthorized disclosure of, or access to personal data. This includes hacking, lost devices, misdirected emails, and improper disposal.
Who should fill out this form?
The person who discovered the breach or the incident response team lead should complete the form. Technical details can be added by IT/Security staff. The Data Protection Officer should review before regulatory submission.
Should we complete the form even for suspected breaches?
Yes, document suspected breaches immediately. You can update the report as investigation reveals more details. It's better to document early and downgrade if unfounded than to miss the reporting window for a real breach.
How is severity determined?
Severity depends on: type of data affected (sensitive data = higher severity), number of records, likelihood of harm to individuals, whether data was encrypted, and whether the breach was malicious. This form guides you through these factors.