Information Technology Services

Report an information security incident

Use this electronic form to report an information incident to the Information Security Officer. Include details of the incident and contact information.

Security Incident Reporting Form
	Contact Information Name of person reporting: Address: Phone: Email: System Information IP Address: MAC Address: DNS Name: DHCP Registered Support NetID: Dept: Name: NetBIOS Information Computer name: Domain: Logged in user: Building: Location:		Detail of incident: Problem Type: If other problem type, please explain: Affiliation Student Faculty Staff Other If other affiliation type, please list:

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