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["Data Breach Notification Form"]
["pursuant to Art. 33 of the General Data Protection Regulation"]
[]
["0. General Information",null,null,null,null,null,"Explanatory notes",null,{"$f":"NOW()","v":"2018-07-02T11:10:54.660"}]
["Type of notification",null,null,null,null,null,"1) Preliminary, in case that not all information on the data breach is available and a new version of the form is going to be submitted in the (near) future\n2) Complementary-Amended, in case that  new information on a previously notified data breach is provided\n3) Complete, in case that all necessary information on the data breach is provided",null,"ΝΑΙ"]
["Date of the previous submission of the notification form for this incident",null,null,null,null,null,"To be completed in case that this notification is complementary-amended",null,"OΧΙ"]
["1. About you (data controller)",null,null,null,null,null,null,null,{"$f":"IF(ISBLANK($B$24),0,$I$4-$B$24)","v":0}]
["1.1 Contact Information"]
["Name of the organization"]
["General Commercial Registry Number (if available)"]
["VAT Number"]
["Any relevant contact details"]
["Name and function of the person who can be contacted for more information about the breach"]
["email address"]
["Phone number"]
["Postal address"]
["1.2 Involvement of others outside the data controller  for the service concerned by the data breach"]
["Involvement of others outside the data controller  for the service concerned by the data breach? "]
["Name and qualification of the other involved party",null,null,null,null,null,"Enter here the name and the status of the other organisation(s) involved in the breach, and explain their involvement (to be completed only in case that the answer provided above is YES) "]
["2. Timeline "]
["Ongoing breach?"]
["Beginning date and time of the breach\n (year/month/date/time)",null,null,null,null,null,"If you do not know the date/time precisely, please indicate the approximate date."]
["Ending date and time of the breach\n (year/month/date/time)",null,null,null,null,null,"Το be completed, in case that the breach is not ongoing. If you do not know the date/time precisely, please indicate the approximate date."]
["Date and time of becoming aware of the breach (year/month/date/time)",null,null,null,null,null,"If you do not know the date/time precisely, please indicate the approximate date."]
["Means of detection of breach"]
["Reasons for late notification of breach",null,null,null,null,null,"To be mandatorily completed, in case that more than 72 hours have been passed since you became aware of the breach"]
["Date of notification by processor\n (year/month/day/time)",null,null,null,null,null,"If you do not know this date/time precisely, please indicate the approximate date (to be completed only in case that a data processor has notified the data breach to you)"]
["Comments on the dates",null,null,null,null,null,"Optional field; you can provide, if you think nessecary,  more information regarding the dates of notification and indicate if you do not know the dates exactly"]
["3. About the breach"]
["Breach of confidentiality?","ΌΧΙ",null,null,null,null,"You fill YES in case of unauthorized disclosure of the data or unauthorized access to the data etc."]
["Breach of integrity?",null,null,null,null,null,"You fill YES in case of alteration/modification of data etc."]
["Breach of availability?",null,null,null,null,null,"You fill YES in case of loss or destruction of data etc."]
["Nature of the incident",null,null,null,null,null,"Indicative examples:\n1) Device lost or stolen\n2) Paper lost or stolen or left in insecure location \n3) Mail lost or opened\n4) Hacking\n5) Malware (e.g. virus, ramsonware)\n6) Phishing\n7) Incorrect disposal of personal data (either on paper or in electronic format)\n8) Unintended publication\n9) Data of wrong data subject shown\n10) Personal data shown to data recepient\n11) Verbal unauthorized disclosure of personal data\nand others (please specify)\n"]
["Cause of the breach",null,null,null,null,null,"Indicative examples: \n1) Internal non-malicious user\n2) Internal malicious user\n3) External malicious user \n4) Forces of nature (fire, flood, etc.)\n5) Obsolete hardware\n6) Obsolete software\n7) Unknown\nand others (it may be a combination of the above)"]
["4. Type of breached data"]
["4.1 Regular data"]
["Data related to identification/authentication of data subject (first name, last name, account (login) name, password etc.) "]
["If YES, specify",null,null,null,null,null,"If YES, specify the type of the data"]
["ID Card/passport Number"]
["If YES, specify"]
["Tax Identification Number "]
["Social Insurance Number "]
["Other identification data"]
["If YES, specify",null,null,null,null,null,"If YES, specify the type of the \nidentification data"]
["Date of birth "]
["Contact details (e.g. postal or electronic mail address, phone number etc.) "]
["If YES, specify",null,null,null,null,null,"If YES, specify which contact details"]
["Economic and financial data"]
["If YES, specify"]
["Location data "]
["If YES, specify",null,null,null,null,null,"If YES, specify which type of location data"]
["Official documents "]
["If YES, specify",null,null,null,null,null,"If YES, specify the type of documents"]
["Criminal convictions, offence or security measures"]
["If YES, specify"]
["Other"]
["If YES, specify",null,null,null,null,null,"If YES, specify the type of data"]
["Unknown"]
["If YES, describe the reasons",null,null,null,null,null,"If YES, describe why you don't know the type of breached data"]
["4.2 Special categories of data"]
["Data revealing racial or ethnic origin "]
["If YES, specify"]
["Political opinions "]
["Religious or philosophical beliefs "]
["If YES, specify"]
["Trade union membership "]
["If YES, specify"]
["Genetic data "]
["If YES, specify"]
["Biometric data"]
["If YES, specify"]
["Health data"]
["If YES, specify"]
["Data concerning sex life or sexual orientation  "]
["Other"]
["If YES, specify",null,null,null,null,null,"If YES, specify the type of data"]
["5. About the data subjects "]
["Approximate number of personal data records concerned by the breach"]
["Approximate number of data subjects (persons) concerned by the breach"]
["Employees "]
["Users (e.g. on an online service)"]
["Subscribers "]
["Students"]
["Military staff "]
["Customers (current and prospects) "]
["Patients  "]
["Minors "]
["Other"]
["If YES, specify"]
["Unknown"]
["If YES, describe the reasons",null,null,null,null,null,"If YES, describe why you don't know the categories of concerned data subjects"]
["Detailed description of the concerned data subjects",null,null,null,null,null,"Provide details on the information given above "]
["6. About the measures in place BEFORE the breach"]
["Detailed description on the measures in place before the breach"]
["7. Consequences"]
["7.1 Breach of confidentiality"]
["Larger dissemination than necessary or consented by data subjects (YES/NO)",null,null,null,null,null,"At least one of them should be filled, in case that you answered YES in Section 3 with regard to the breach of confidentiality "]
["Data may be linked with other information of the data subjects (YES/NO)"]
["Data may be used for other purposes and/or unfair manner (YES/NO)"]
["Other (YES/NO- If YES, specify)"]
["7.2 Breach of integrity"]
["Data may have been modified and used even though it is no longer valid (YES/NO)",null,null,null,null,null,"At least one of them should be filled, in case that you answered YES in Section 3 with regard to the breach of integrity"]
["Data may have been modified into otherwise valid data and subsequently used for other purposes (YES/NO)"]
["Other (YES/NO- If YES, specify)"]
["7.3 Breach of availability"]
["Loss of the ability to provide a critical service for the affected data subjects (YES/NO)",null,null,null,null,null,"At least one of them should be filled, in case that you answered YES in Section 3 with regard to the breach of availability"]
["Alteration of the ability to provide a critical service to the affected data subjects (YES/NO)"]
["Other (YES/NO- If YES, specify)"]
["7.4 Physical, material or non-material damage or significant consequences to the data subjects "]
["Nature of the potential impact for the data subject",null,null,null,null,null,"Indicative examples: \n1) Loss of control over their personal data\n2) Limitation of their rights\n3) Discrimination\n4) Identity theft\n5) Financial loss\n6) Damage to reputation\n7) Loss of confidentiality of personal data protected by professional secrecy\n8) Unauthorised reversal of pseudonymisation\n \nand others (please specify)\n\n"]
["Severity of the potential impact (Negligible - Limited - Significant - Maximal)",null,null,null,null,null,"Indicate here the result of your self-assessment of the severity of the impact of the breach for the data subjects."]
["8. Actions AFTER the breach "]
["8.1 Communication to data subjects"]
["Have you informed the concerned data subjects about the breach; ",null,null,null,null,null,"In case that you answered \"NOT DECIDED AT THIS TIME\", a complementary/amended form should be submitted in the near future for this incident"]
["Date of when information was given to data subjects if they already have been informed (year/month/day)",null,null,null,null,null,"Please indicate here the date on which you have started to inform the data subjects, in case that you answered YES in the first question of  the Section 8.1 "]
["Number of data subjects informed",null,null,null,null,null,"To be filled in case that you answered YES in the first question of the Section 8.1 "]
["Means of communication used to inform the data subjects",null,null,null,null,null,"E.g.: email, phone call, snail mail, etc.\nTo be filled in case that you answered YES in the first question of the Section 8.1."]
["Content of the information delivered to the data subjects",null,null,null,null,null,"Please attach the relevant document (e.d..PDF, DOC, DOCX, JPG, open document, etc.). \nTo be filled in case that you answered YES in the first question of the Section 8.1."]
["Date of future information of the data subjects if they have not been informed yet (year/month/day or Unspecified, if this data has not been specified yet).",null,null,null,null,null,"To be filled in case that you answered NO, BUT THEY WILL BE INFORMED in the first question of the Section 8.1."]
["Reasons for not informing data subjects",null,null,null,null,null,"To be filled in case that you answered NO  in the first question of the Section 8.1. \nPossible reasons:\n1) The controller has implemented appropriate technical and organisational protection measures, and those measures were applied to the personal data affected by the personal data breach, in particular those that render the personal data unintelligible to any person who is not authorised to access it ; \n2) The controller has taken subsequent measures which ensure that the high risk to the rights and freedoms of data subjects is no longer likely to materialise\n3)  It would involve disproportionate effort to inform each data subject individually\n"]
["Description of measures allowing to skip information of data subjects ",null,null,null,null,null,"To be filled in case that you answered NO  in the first question of the Section 8.1 and, as a reason for not informing, you stated  above that appropriate measures have been taken."]
["Public communication or similar measure",null,null,null,null,null,"To be filled in case that you answered NO  in the first question of the Section 8.1 and, as a reason for not informing, you stated  above that  would involve disproportionate effort to inform each data subject individually"]
["8.2 Measures taken to address the breach"]
["Description of the measures taken by the controller to address the breach"]
["8.3 Cross border and other notifications"]
["Is this notification a cross border notification made to your lead supervisory authority? "]
["List of EU countries concerned by the breach",null,null,null,null,null,"Indicate here the countries concerned by the breach, in case that you answered YES in the first question of  8.3 "]
["Has the breach been or will it be notified directly to other concerned EU Supervisory Authority? "]
["List of other concerned EU \n Superisory Authorities",null,null,null,null,null,"If YES, plase indicate here the list of the other EU Supervisory Authorities you have notified or plan to notify, with explicit reference to the lead supervisory authority"]
["Has the breach been or will it be notified to Data Protection Authorites outside the EU? "]
["List of other data protection authorities outside the EU",null,null,null,null,null,"If YES, plase indicate here the list of the other data protection authorities outside the EU to which the breach has been or will be notified "]
["Has the breach been or will it be notified to other EU regulators because of other legal obligations?  (NIS directive eIDAS regulation)?"]
["List of the other EU regulators",null,null,null,null,null,"If YES, please indicate here the list of the other EU regulators, with explicit reference to the legal obligation (e.g. NIS Directive, eIDAS Regulation)"]