Cybersecurity Incident Form Step 1 of 5 20% Contact InformationStatus of Incident*Select OneCurrently experiencing issue, no ticket openCurrently experiencing issue, incident openInvestigation in process, ongoing issueInvestigation in process, issue resolvedPast incidentRepeat incidentIncident closed & resolved, requesting more informationYour Name:* First Last Your Title:*Your UWM Email Address* Your Phone*Your Campus/Department/College:*Are You the Affected User?* Yes No Name & Contact of User (Student, faculty, staff, etc. if different from above)Name First Last UWM Email Address* PhoneTitleCampus/Department/College: Location of Compromised MachineIs the device located in a building on campus?* Yes No, located at home No, located in UWM building off main campus Building NameARCHITECTURE & URBAN PLANNING BUILDINGART BUILDINGARTS CENTERARTS LECTURE HALLAURORA SINAI MEDICAL CENTERBOLTON HALLCAMBRIDGE COMMONSCAPITOL-HUMBOLDT UPARK SECURITY STATIONCHAPMAN HALLCHEMISTRY BUILDINGCOMMUNITY AUDIOLOGY SERVICESCONTINUING EDUCATION PLANKINTON BUILDINGCOZZENS & CUDAHY RESEARCH CENTERCUNNINGHAM HALLCURTIN HALLEASTLAKE TOWERSELECTRICAL SUBSTATION EASTELECTRICAL SUBSTATION WESTENDERIS HALLENGELMANN HALLENGELMANN STADIUMENGINEERING & MATHEMATICAL SCIENCES BUILDINGGARLAND HALLGOLDA MEIR LIBRARYGREAT LAKES RESEARCH FAC. LAND AND SLIPGREAT LAKES RESEARCH FACILITYGREAT LAKES RESEARCH FACILITY – GREENHOUSEGREENE HALLGREENE MUSEUMGROUNDS BUILDINGHEATING PLANTHEFTER CONFERENCE CENTERHOLTON HALLHONORS HOUSEHOUSE OF PEACEINDEPENDENT UNITED HEALTH PARTNERSINNOVATION PARKJOHNSTON HALLKENILWORTH SQUARE APARTMENTSKENILWORTH SQUARE EASTKENWOOD IRCKLOTSCHE CENTERKUNKLE CENTERLAPHAM HALLLUBAR HALLMEDICAL COLLEGE OF WISCONSINMELLENCAMP HALLMERRILL HALLMILWAUKEE HIDTA OFFICEMITCHELL HALLMOYNIHAN FIELDMUSIC BUILDINGNORRIS HEALTH CENTERNORTHWEST QUADRANT ANORTHWEST QUADRANT BNORTHWEST QUADRANT CNORTHWEST QUADRANT DNORTHWEST QUADRANT ENORTHWEST QUADRANT GARAGEPAVILIONPEARSE HALLPHYSICS BUILDINGPUMPING STATIONPURIN HALLRING BUILDINGRIVERVIEW RESIDENCE HALLSABIN HALLSANDBURG RESIDENCE HALLSANDBURG RESIDENCE HALL COMMONSSANDBURG RESIDENCE HALL EAST TOWERSANDBURG RESIDENCE HALL NORTH TOWERSANDBURG RESIDENCE HALL SOUTH TOWERSANDBURG RESIDENCE HALL WEST TOWERSAUKVILLE FIELD STATION LABORATORY BUILDINGSAUKVILLE FIELD STATION MACHINE SHEDSAUKVILLE FIELD STATION MANAGER'S RESIDENCESAUKVILLE FIELD STATION OVERNIGHT QUARTERSSAUKVILLE FIELD STATION RESEARCH BUILDINGSAUKVILLE FIELD STATION SERVICE BUILDINGSILVER SPRING NURSING CENTERTHEATRE BUILDINGTV SIX TOWERUNIVERSITY SERVICES AND RESEARCH BUILDINGUWM UNIONVOGEL HALLWEST ALLIS 70TH STREETWUWM CHASE TOWERZELAZO CENTER FOR THE PERFORMING ARTSZILBER SCHOOL OF PUBLIC HEALTH BUILDINGRoom Number/Location Information Description of Compromised MachinePlease select any of the identifying information you have to describe the affected device: IP Address Operating System Make/Model Serial Number Computer Name MAC Address DNS Entry Domain/Workgroup Ports Used Modem Used Telephone Number Used IP AddressOperating SystemMake and ModelSerial NumberComputer NameMac AddressDNS EntryDomain/WorkgroupPorts UsedModem UsedTelephone Number Used Incident DetailsDate* MM slash DD slash YYYY Time* : Hours Minutes AM PM AM/PM Your Time ZoneSelectPacificMountainCentralEasternMain Impact of the Incident*Select OneFinancial LossData LossSystem DowntimeDamage to SystemsOrganizations Systems AffectedOtherNumber of Users, Networks, or Departments Affected:Approximate or preciseDescribe the ImpactNumber of Hours of WorkedPlease enter a number greater than or equal to 1.Approximately how long it took to mitigate the issueHourly RatePlease enter a number greater than or equal to 1.Approximate hourly pay received by everyone who completed the workTotal Dollar Amount Spent to Fix the IncidentPlease enter a number greater than or equal to 1.Approximate or precise Additional InformationDo you know what kind of attack this was?* Yes No Do you know the source of this attack?* Yes No Do you have any available logs?* Yes Unsure No (E.g. Audits, Events, or Connections)Type of AttackType of Attack (select all that apply) Denial of Service/Distributed Denial of Service Misuse of Systems (internal or external) Malicious Code (virus/trojan/worm) Website Defacement Unauthorized Intrusion Probe/Scam Unauthorized Electronic Monitoring (sniffing) Other Please describe your experience:Other relevant details of attack and its detection:Source of IncidentComputer Name:User ID:Internet Domain Name (Please Attach Registration):Source Port:IP Address:MAC Address:Available LogsAudit: Yes No Cut-n-paste entries to show activity:(If possible burn all logs to a CD or best offline storage to be kept for further review if needed)Event Yes No Cut-n-paste entries to show activity:Connection: Yes No Cut-n-paste entries to show activity:EmailThis field is for validation purposes and should be left unchanged.