Report a theft or loss of IT equipment

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Organisation Name*
Name of person completing the form*
First Last
Position*
Email*
Phone
Work base address*
Street Address Address Line 2 City County Postcode

Was the equipment lost or stolen?*
Address/location at which items lost or stolen*
Street Address Address Line 2 City County Postcode
Type of equipment/device*
If other type of equipment please give details*
Make*
Manufacturer of device
Model*
Model number and or name of device
Serial number
Asset number
e.g. PC Number if DCC PC or Laptop

Name of person to which device was assigned*
First Last
Describe any personal data held on the equipment*
information about individuals
Describe any other type of information that was on the device*
e.g. business information

Provide a description of the incident*
Who was in the building at the time of the incident?*

Date equipment was last seen/used*
DD
MM
YYYY
Time equipment was last seen/used*
: HH
MM
Approximate value of item*
Names of any witnesses
If anyone saw anything suspicious on that day or previous day, give details

How did the thief gain access to the equipment?*
Give details of any evidence of a break-in or damage to other equipment?*
Was anything else relating to the equipment stolen?*
e.g. manuals, carry case

Please give full details of security controls in operation at time of theft or loss*
Please give full details of security controls in situ, but not in operation at time of theft or loss*
Has the site been secured?
- Yes
- No
What is needed to secure the site?*
e.g. Replace glass, change locks, change passwords?
Roughly, what is the expected cost of clearing up and securing the site?*
What action could be taken to prevent re-occurrence?*

Have the police been informed?*
Date Police Notified*
DD
MM
YYYY
By whom?*
Police station at which theft reported*
Name of police officer handling the case*
First Last
Crime reference number*
Are the police going to visit?*
Date form completed*
DD
MM
YYYY
Consent*
- I agree to the privacy notice.
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