ICO Data Protection Breach Notification Form

This is a template to manage breach and incident reporting to the ICO. It includes custom fields to manage the breach as well as allowing reports to be generated that show the progress of the work. 

This form is to be used when data controllers wish to report a breach of the Data Protection Act to the ICO. It should not take more than 15 minutes to complete.

If you are unsure whether it is appropriate to report an incident, you should read the following guidance before completing the form: Notification of Data Security Breaches to the Information Commissioner’s Office. 

Please provide as much information as possible and ensure that all mandatory (*) fields are completed. If you don’t know the answer, or you are waiting on completion of an internal investigation, please tell us. In addition to completing the form below, we welcome other relevant supporting information, eg incident reports.

In the wake of a data protection breach, swift containment and recovery of the situation is vital. Every effort should be taken to minimise the potential impact on affected individuals, and details of the steps taken to achieve this should be included in this form. 

1) Re-name this template using your organizational standard so that it is specific to the breach you are reporting to the ICO.
2) Create User fields for Assigned to, Reviewer and Approver (if required)
3) Answer each question, and provide supporting evidence as attachments as required. 
4) Use filters and reports to manage your work.
5) Use the notes to keep track of new information.
6) Once all the fields are completed as fully as possible in the allocated time, export this form to Word, convert to PDF and send to the ICO using the instructions below.


Send your completed form to, with ‘DPA breach notification form’ in the subject field, or by post to: The Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF. Please note that we cannot guarantee security of forms or any attachments sent by email. 

What happens next? 

When we receive this form, we will contact you within seven calendar days to provide: 

* a case reference number; and
* information about our next steps 

If you need any help in completing this form, please contact our helpline on 0303 123 1113 or 01625 545745 (operates 9am to 5pm Monday to Friday)

Was this article helpful?
0 out of 0 found this helpful
Have more questions? Submit a request


Please sign in to leave a comment.
Powered by Zendesk