NCDHHS Privacy and Security Office - Incident Reporting Form

  1. Do not put confidential data in the initial ticket.
  2. Fields marked with * are required.
  3. For anonymous reporting:
    • Name - may be anonymous
    • Email - may be fictitious (or) use [email protected]
    • Phone - may be fictitious (or) use 000-000-0000
  4. Ensure information is accurate and all required fields are completed.
  5. Click "Submit". Note: Once submitted, the information is sent to the DHHS Privacy and Security Office.
If you have any questions, please contact the DHHS Privacy Security Office at [email protected].



Summary of Incident:*

If you are human, please do not use this field.