Privacy Act Breach Report Form for Government of Canada Institutions

This form is being offered to you as an on-line service and is available to you in Rich Text (RTF) and Portable Document (PDF) formats.

If you choose either the RTF format or the PDF format, you will have two options for completing the form:

1. Fill in the form on-screen, save it for submission by email or print it for submission by mail;
2. Print the form and fill in the fields by hand for submission by mail.

If you choose the PDF format, you might need a reader to view the form. Please go to the Adobe Acrobat Reader download page.

• RTF format: Please save the form on your computer before completing.
• PDF format: Please save the form on your computer before completing.

Please submit this form to the Office of the Privacy Commissioner of Canada and the Treasury Board of Canada Secretariat through one of the following means: