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Name
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First
Last
Email Address
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Please provide a valid email address so we can get back to you
How Data is handled
What type of sensitive information does your company handle, access, or store?
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Personal Data
Social Insurance Numbers
Employment data
Driver’s License Numbers
Credit card numbers
Banking and/or investment data
Health care information
Medical records or medical history
Intellectual property
Unsure
Check all that apply, including employee data as well as client data.
Do you allow any of the above information to be e-mailed?
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— Select —
Yes
No
Unsure
Not Applicable
Do you allow any of the above information to be stored or transmitted in cloud file-sharing applications like Dropbox, Google Drive, etc.?
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— Select —
Yes
No
Unsure
Not Applicable
Insurance
The following questions are about your current insurance policies
Do you have a cyber liability insurance policy?
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Yes
No
Do you have theft insurance?
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Yes
No
How recently have you evaluated the level of cyber insurance carried by your organization to verify if it is adequate to protect your organization and your clients or patients from financial loss?
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— Select —
I Don't Know
90 Days
180 Days
1 Year
3 Years
Policies
The following questions are about your current office policies
Do you have a work from home policy that includes safeguards for client, patient, and organization data?
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— Select —
Yes
No
Unsure
Not Applicable
Do you have a “clean desk” policy asking employees to not leave sensitive documents lying on their desk when unattended?
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— Select —
Yes
No
Unsure
Not Applicable
What cyber security policies are being used in your office?
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Acceptable Use Policy
Password Policy
Data Confidentiality Policy
Mobile Device Policy
Bring Your Own Device (BYOD) Policy
Incident Response Policy
Backup and Disaster Recovery Plan
Business Continuity Plan
Remote Access Policy
IT Asset Disposal Policy
Security Awareness Policy
3rd-Party Access Policy
Removable Media Policy (USB Drives/Sticks)
User Termination Policy
I don’t know if we have any of these
Do employees sign off that they have read and understand these policies?
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Yes
No
Where do you store your list of user credentials (username and passwords)?
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