Privacy Breach Report

A privacy breach occurs when there is unauthorized access to or collection, use, disclosure or disposal of personal information.

To report a privacy breach, complete and submit this online form. Fields marked with an asterisk (*) are mandatory, i.e. the form will not submit if they are left blank. Please note that you cannot save this form; you must complete it and submit it in a single session. Upon submitting the form, you will receive an email that includes all the data that you entered. The Information and Privacy Officer may contact you with follow-up questions upon receiving your report.

Contact information

Incident description

Accessed or disclosed outside Canada?
Was the personal information accessed from or disclosed outside Canada?
Stored on server outside Canada?
Is the personal information being stored on a server or servers outside Canada? If yes, provide name of service provider and location of server(s) below
Enter city and country

Individuals affected

Types of individuals affected

Personal Information breached

Types of personal information breached
Select all that apply; elaborate below in "Additional information relating to personal information breached"

Safeguards

Existing physical security measures
Select all that apply; elaborate below in "Additional information relating to safeguards"
Existing technical security measures
Select all that apply; elaborate below in "Additional information relating to safeguards"
Existing procedural security measures
Select all that apply; elaborate below in "Additional information relating to safeguards"

Harm resulting from breach

Types of harm resulting from breach
Select all that apply; elaborate below in "Additional information relating to harm"

Mitigation and prevention

Immediate steps taken to contain and reduce harm resulting from breach
Select all that apply; elaborate below in "Additional information relating to mitigation and prevention"
Long-term strategies to correct the situation
Select all that apply; elaborate below in "Additional information relating to mitigation and prevention"