Assessment

Veteran Owned Business

Privacy and Security
Sample Assessment

This assessment in not intended to find fault with any system or process within your organization. It is the mission of Privacy Consulting Group, LLC to provide services and products to enhance the security and privacy of protected data and intellectual property which supports the reputation and financial well-being of your organization.

Please complete all information about your organization so that we may accurately assess your need for privacy and security services. Please respond to each assessment question by checking one of the options next to each question that best describes your organizations current policies.

Organization Name:
Physical Address:
Mailing Address:
City:
State:
ZIP:
Phone:
FAX:
Organizational E-mail:
Type of Business:	Hospital
	Medical/Dental Group
	Private Medical/Dental Provider
	Title Company
	Government Agency
	Other
Number of Employees:
Number of Facilities/Offices:
Contact Person:
Contact Phone:
Contact FAX:
Contact Email:
Briefly describe your organizations client/customer base:
Briefly describe your organizations expectations for privacy and security:

Assessment Questions

Does your operating system, network, desktop, programs include all of the most recent product updates?	Yes No Unknown

Does your ISP/IT vendor provide virus protections?	Yes No Unknown

Are information system user accounts managed on a need to know basis?	Yes No Unknown

Are users required to periodically change passwords?	Yes No Unknown

Does your organization use encryption to protect mobile data?	Yes No Unknown

Are there written standards for use of the organizations computers?	Yes No Unknown

Have employees been told how to handle a data breach?	Yes No Unknown

Do you know who you must contact if a breach of protected information happens?	Yes No Unknown

Has your organization assigned an individual to speak with media if a breach happens?	Yes No Unknown

Within 48 hours of submitting this self assessment *Privacy Consulting Group, LLC* will provide you with the results of your assessment and appropriate suggestions for actions to improve your security and privacy processes. Thank you for selecting *Privacy Consulting Group, LLC* for your privacy, security, and compliance solutions.

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