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Massachusetts Department of Criminal Justice Information Services
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DCJIS INFORMATION SECURITY OFFICER (ISO)
COMPUTER/INFORMATION SECURITY INCIDENT REPORT FORM
AUTHORITY: M.G.L. c. 6, § 167A and the FBI CJIS Security Policy COMPLIANCE: Mandatory;
PENALTY: Loss of access to criminal justice information systems
Agencies shall report criminal justice information system incidents to the DCJIS ISO within 48 hours in compliance with the FBI CJIS Security Policy. Please Print
or Type your responses. If a question does NOT apply, enter "N / A" to signify not applicable.
Mail or Email Completed Form To:
Massachusetts Department of Criminal Justice Information Services
ATTN: Information Security Officer
200 Arlington Street, Suite 2200
Chelsea, MA 02150
cjis.support@state.ma.us
For Additional Information:
FBI CJIS SECURITY POLICY
Questions / Comments:
Christopher Schreiner
Phone: 617.660.4603
I. Agency Information
Point(s) of Contact (First Name, Last Name, M.I.) Agency Name Agency ID
Agency Address
City
State
Zip Code
Work Phone Number
Email Address
Date of Report Date of Incident
II. Incident Information
Location(s) of Incident:
System(s) and/or Data Affected (e.g., CAD, RMS, File Server, etc.):
Method of Detection:
Nature of Incident:
Incident Description:
Actions Taken / Resolution:
III. Incident Report
1. How was the incident discovered? (e.g. via an audit trail, or accidental discovery)