PB (P)

Your personal information is being collected pursuant to Section 4(c) of the Protection of Privacy Act for the purpose of investigating your reported privacy complaint and to allow The City of Calgary to contact you during the investigation. This information may be input into an automated system to generate content or make decisions, recommendations, or predictions. If you have any questions about this collection, please contact the City of Calgary FOIP Coordinator by phone at 403-268-5861 (option 2) or email AccessandPrivacy@calgary.ca.

Contact Information

First Name

Last Name

How do you want to receive correspondence from the Access to Information and Investigations office?

Address

City

Province

Other

Postal Code

Phone Number

Email Address for Correspondence with Access to Information and Investigations

Confirm Email Address

Incident Description

Privacy Complaint Description

Unauthorized access to your personal information

Unauthorized collection of your personal information

Unauthorized disclosure of your personal information

Unauthorized use of your personal information

Description of Privacy Incident

(Please provide as much detail about the incident but do not include third-party personal information, including the names of involved employees. Access to Information and Investigations will contact you if additional information is required.
Please include the following details, if known:

A description of the privacy incident, including what happened and when it occurred;
The type of personal information involved;
How you became aware of the issue;
Any actions taken so far to address the issue.)

Personal Information Involved

Name

Contact Information

Demographic Information (e.g. ethnicity, age, sex)

Identifying Number (e.g. SIN, Alberta Health Number, employee ID)

Financial Information

Medical Information

Other

Other Description

Notification

Have you notified anyone else at The City of this incident yet?

If yes, whom?

Confirmation

I confirm that the information provided on this form is accurate and complete to the best of my knowledge.

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Privacy Incident Intake (External)

Contact Information

Contact Information

Incident Description

Privacy Complaint Description

Personal Information Involved

Personal Information Involved

Notification

Notification

Confirmation