Notes on Data Breach according to the General Data Protection Regulation (GDPR)

    Contact details of the reporter

    Please fill in the following fields. We will contact you as soon as possible.

    Name of the responsible entity *
    e.g.: of the company, the authority

    Street and house number *

    Zip * :

    City * :


    Name of the reporting person * :

    Function of the reporting person * :

    E-mail address of the reporting person * :

    Telephone number of the reporting person * :

    Description of the Databreach *
    Please describe the incident as precisely as possible.
    Where did the incident happen?
    Who was involved?
    How did you find out about it?
    Has the responsible organization been informed yet?
    Which third parties have become aware or had the opportunity to become aware?

    Time of the Databreach *

    Time of knowledge of the Databreach *

    What types of data are affected? *

    e.g. employee data, customer data, bank account data, health data

    The data of how many people are involved? *

    If the exact number of people affected is not known, please provide an estimated upper limit.

    Risk assessment: What do you consider to be the likely consequences of a personal data breach? *

    e.g. unauthorized account debits, identity theft, damage to reputation/image, threat to livelihood, threat to life, exposure, identity theft, disclosure of secrets.

    What countermeasures have you already initiated, and what further countermeasures are planned? *

    In your opinion, do you have an obligation to notify the data subjects (Art. 34 GDPR)? *


    Have criminal charges been filed?
    Other information