This form is used to allow a department or individual to document
suspected student, staff, or faculty confidential information stored,
accessed and transmitted electronically at Shawnee State University.
Shawnee State offers a comprehensive definition of student, staff, or
faculty information residing on university or personally-owned storage
devices that is considered confidential in nature, in the UTAC-approved
Conditions for Confidential Information
document.
Information submitted on this form will be forwarded to the Director of
UIS for evaluation. It may also be shared with other SSU employees
charged with the task of identifying SSU's responsibility for defining a
strategy to protect confidential data.
Submitting the requested information below for each file or database you
or your department creates, that is comprised of confidential
information, will ensure it is included in the scope of secure storage. |
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Point of Contact (POC) information |
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Name: |
Job Title:
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Dept: |
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Work Phone:
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Email: |
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Report Date:
Time:
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Location of Audit:
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Nature of Audit:
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Description of Audit:
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Description of Confidential Information:
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Name of Document:
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Information Format:
Electronic
Paper |
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Location of File:
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(BE SPECIFIC. For example, your PC or laptop's hard drive
(include path (ex. C:\Document and Settings\...), file cabinet, etc) |
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Other Locations of File or Other
Format of File: (ex. your PC's hard drive, CD backup,
additional paper copy etc)
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Is Data Transmitted Electronically Offsite:
Yes
No
Unknown |
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Offsite Transmittal
Destination:
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Offsite Transmittal Method:
Dialup Modem
FTP
Internet Based |
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Electronic Data Format:
Spreadsheet
Database
Word Document
Email
Other |
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Electronic Media Format:
CD/DVD
Hard Drive
Floppy
External Storage Device
USB Drive
Mobile
Storage Device
Tape
Disk |
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Data Accessibility:
Encrypted
Unencrypted
Redacted
Unredacted
Unknown |
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Is Shared Access to Data Currently Possible:
Yes
No
Unknown |
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Other Individuals Currently
Accessing Data:
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