"*" indicates required fields Step 1 of 8 12% Organisation Name*Please note, this form is intended for use by our client organisations to report a theft or loss of IT equipment. Any theft loss should also be reported as per the client organisations procedures.Name of person completing the form* Full name Position*Email*PhoneWork base address* Street Address Address Line 2 City County Postcode Was the equipment lost or stolen?*LostStolenAddress/location at which items lost or stolen* Street Address Address Line 2 City County Postcode Type of equipment/device*LaptopMobile PhoneTabletPCOtherIf other type of IT equipment please give details*0 of 40 max charactersMake*Manufacturer of device0 of 25 max charactersModel*Model number and or name of device0 of 40 max charactersSerial numbermanufacturer serial number if known0 of 30 max charactersAsset numbere.g. PC number if DCC Laptop0 of 25 max characters Name of person to which device was assigned* Full name Describe any personal data held on the equipment*information about individualsDescribe any other type of information that was on the device*e.g. business information Provide a brief description of the incident*0 of 500 max charactersWho was in the building, or present, at the time of the incident?* Date equipment was last seen/used* DD slash MM slash YYYY Time equipment was last seen/used* Hours : Minutes Approximate value of item*0 of 15 max charactersNames of any witnesses200If anyone saw anything suspicious on that day or previous day, give details0 of 200 max characters How did the thief gain access to the equipment?*0 of 200 max charactersProvide details of any evidence of a break-in or damage to other equipment?*0 of 200 max charactersWas anything else relating to the equipment stolen?* e.g. manuals, carry case0 of 200 max characters 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?Approximately, 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?*YesNoDate Police Notified* DD slash MM slash 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?*Have you registered the theft/loss of the equipment on the National Property Register?*Some of our client organisations require that the theft or loss of IT equipment is reported via the National Property Register, https://www.immobilise.com Please refer to your organisations guidance.YesNoThird ChoiceDate reported on the National Property Register* MM slash DD slash YYYY Date form completed* DD slash MM slash YYYY Consent* I agree to the privacy notice. CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Δ