Our website uses cookies so we can analyse our site usage and give you the best experience. Click "Accept" if you’re happy with this, or click "More" for information about cookies on our site, how to opt out, and how to disable cookies altogether.

We respect your Do Not Track preference.

Notify Us

Your responsibilities

If you are concerned someone's life is in danger, please call 111, then come back to us.


This self-assessment does not ask for any information that identifies you or your organisation. No information you enter is sent to us unless at the end of the self-assessment, you elect to go on to submit a privacy breach notification to us. Nothing you enter in this self-assessment or go on to submit to us is stored on our website. 

It is important to note that this self-assessment tool is only a guide. Every breach is different and we are not limited to the self-assessment result when assessing if any decision not to notify us was reasonable in the circumstances. 

If you are unsure which answer value to choose when you complete the self-assessment, we encourage you to err on the side of caution.  

Summary of your report update

Please review your responses before you submit your update. You will be able to print a copy of your update after you submit it.

Contact details
About the organisation
Organisation name
NZBN number
Sector
Industry classification
Your contact details
First name
Last name
Job title
Email
Phone number
Are you acting as an agent for the organisation?
Name of agent organisation
Timeline
Is the problem that caused this breach ongoing?
Date of breach
Date the breach was identified by your organisation
About the breach
Number of people affected
Type of personal information involved in the breach
Type of breach
Tell us what happened
Tell us what happened
Tell us what happened
Do you know where the information has gone?
Where has the information gone?
Likely harm
How sensitive is the information that is involved in the breach?
Who has obtained or may obtain the information?
What types of harm may be caused to people affected by the breach?
Discriminatory harm
Emotional harm
Employment harm
Financial harm
Identity theft
Loss of access to information
Loss of opportunity
Physical harm
Reputational harm
Threats of harm
Other:
How likely is it that someone will be harmed because of this breach?
What steps have been taken to reduce the risk of harm or further harm from this breach?
Are there security measures in place that protect the information from being accessed?
Please explain in detail the security measures in place and how they protect the information from being accessed
Is someone's physical safety in immediate danger?
Is someone's psychological safety at immediate risk?
Is someone at immediate risk of serious financial harm?
Notifying Affected People
If the breach is likely to cause serious harm to affected people, have you notified them?
What have you done to notify the people affected?
Why have you not notified the people affected?
What permitted exception(s) are you relying on to not notify the people affected at this time?
Please explain why you are relying on the exception(s) you have indicated.
Why, and for how long, are you delaying notifying the people affected?
Are you relying on giving public notice to notify the people affected?
Why are you relying on giving public notice to notify the people affected?
Other Organisations
Were any other organisations affected by the breach?
Please name the other affected organisations and explain how they were affected.
Has the breach been reported to other authorities?
What authorities has the breach been reported to?
Have you contacted any organisations that might be able to provide support to your organisation or people affected by the breach?
What other organisations have you contacted for support with the breach?
Almost done
Please provide any other information you think may be relevant to the breach, or steps you have taken or intend to take in response. (This is an optional field.)
You can upload any attachments here (e.g. copy of any public notice if applicable). The total size limit is 7MB. (This is an optional field.)