Privacy Breach Incident Report

Reporting privacy breaches to the privacy commissioner

Organizations are encouraged to inform the appropriate privacy commissioner(s) of material privacy breaches so they are aware of the breach as this will help them respond to inquiries made by the public and any complaints they may receive. They may also be able to provide advice or guidance to your organization that may be helpful in responding to the breach. Notifying them may enhance the public’s understanding of the incident and confidence in your organization. 

Organizations should refer to the key steps in responding to a privacy breach and the associated checklist released by the Office of the Privacy Commissioner of Canada (OPC) to take the right steps after a privacy breach. These documents are available at the following address: http://www.priv.gc.ca/resource/pb-avp/pb-avp_intro_e.asp.

Privacy breach incident report form

The purpose of the incident report form is to assist organizations in notifying OPC of any material breaches. 

Privacy breach incidents can be reported as follows:

•	By e-mail: notification@priv.gc.ca

•	By phone: (819) 994-5444; Toll-free: 1-800-282-1376; or,
•	By mail:
Notification Officer
Office of the Privacy Commissioner of Canada
30 Victoria Street
Gatineau, Quebec
K1A 1H3

Privacy Breach Incident Report FORM

Date	     	

Name of organization	
     

Contact information: (contact name, telephone number, address)
	     	
Sector		

Third party reporting the breach (if applicable)
	     

Identification of the third party (contact name, telephone number, address)
	     	

Details of Incident

Location, date of incident and discovery
	     	
Description of incident 	     	
Cause (if known)	     	

Estimated number of individuals affected
	     	

Type of individuals affected (e.g. customers, employees)
	     	

Types of personal information involved
	     	

Brief description of action taken to contain breach.
	     	

Has anyone been notified of incident (e.g. affected individuals, law enforcement, other) and when (date)?
	     	

Please submit this form through one of this means of notification:

By e-mail

notification@priv.gc.ca	
By phone

(819) 994-5444
Toll-free: 1-800-282-1376	
By mail

Notification Officer
Office of the Privacy Commissioner of Canada
30 Victoria Street
Gatineau, Quebec
K1A 1H3

If you wish to speak to someone about this breach, 
please call 819-994-5444 or toll-free 1-800-282-1376 and ask for the Notification Officer.