Report a Personal Data Breach
Latest revision date: October 2020
Revision due date: October 2021

Who is this form for?

Please use this form if you feel we have breached in any way yours or others personal data privacy.

We will need to know the following information:
• what’s happened;
• when it happened;
• how you found out about the incident; and
• how this has affected you.

Please give as much detail as you can so we can investigate this further.


Protecting your personal data

By completing this form you acknowledge that we will follow our responsibilities under data protection legislation. We will store the information securely, share it with partners and other statutory agencies where we have the right under law to do this, use it only for the purpose it was provided and process it as set out in our privacy policy. For more information please see our privacy policy on our website.
  • Your Personal Details
  • Title

  • First Name

  • Last Name

  • Address

  • Email Address

  • Phone Number (Optional)

  • If you don’t provide us with this contact information, we may not be able to investigate the report or keep you updated with progress.
  • About the Breach
  • What Council Service does this report relate to?

  • Please tell us
  • When did the breach happen?

    If you don't know the exact date, please tell us your best estimate.

  • Tell us the details of the data breach

  • What would you like us to do to put this right?

  • Have you reported this before?

  • Confirmation
  • By ticking the box below I agree to the following statements:
    • I confirm that the information in this form is true and that you may contact me if you need to discuss the matter further.
    • I understand that if I have not completed this form fully it may result in a delay in us acting on your request.