Genos International Information Security Incident Reporting Form

This form is to be completed as soon as possible following the detection or reporting of an Information Security incident. All items completed should be based on information that is currently available.

1. Contact Information for Person Who Discovered Incident:

2. Incident Details:

3. Impact / Potential Impact:

4. Sensitivity of Data

5. Who Else Has Been Notified?

6. What Steps Have Been Taken So Far?

7. Additional Information

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