Description of Incident:

3. Scope of Incident (Check all that apply)
☐ Critical (e.g. KSU is no longer able to provide some critical services to any user).☐ High (e.g. KSU has lost the ability to provide critical service to a subset of system users).☐ Medium (e.g. KSU can still provide critical services to all users and has lost no efficiency).☐ Low (e.g. No effect to the organization's ability to provide services to all users. Individual impact)☐ Unknown (Provide description below)
Estimated number of systems impacted:
Estimated number of users impacted:
Impact on Third Parties? If so list.
Additional scope information:

4. Impact Categories (Check all that apply)

☐ Loss of Access to Services☐ Loss of Productivity☐ Loss of Reputation or Integrity☐ Loss of Revenue ☐ Propagation to other networks☐ Unauthorized disclosure of data/information☐ Unauthorized modification of data/information☐ Other or Unknown (Provide description below)

Estimated total Cost:

Additional Impact Information:

5. Affected Data (Check all that apply)

5. Affected Data (Check all that apply)

☐ Restricted or Confidential data/information☐ Public data/information☐ Financial data/information☐ FERPA related data/information ☐ Personally Identifiable Information (PII)☐ Intellectual Property/Copyrighted data/information☐ Critical Infrastructure☐ Other or Unknown (Provide description below)

Quantity of Data/Information impacted:

Additional Affected Data/Information: