Sentinel Event Notification Form

As part of the notification process, the Accredited Entity shall provide DirectTrust with the “known facts,” attached to the written notification, and shall continue to provide written notice of additional relevant information as such information becomes “known facts.” The written notice shall be delivered to DirectTrust by email sent to Admin@DirectTrust.org. Written notification must be received by DirectTrust no later than three (3) business days from when the Sentinel Event occurs.

“Known facts” shall include, however not be limited to, (A) any relevant data, information or circumstances regarding a Sentinel Event which an Accredited Entity or Accreditation Candidate (i) is required by law, by a contract to which it is a party, or by any other legal obligation to report or disclose to a third party, or (ii) has disclosed in a public statement or in any non-confidential manner; (B) reports or information that must be reported to a government agency and (C) all findings of fact in the form of an agency action by a duly authorized regulatory agency or in a judgment by a court of original jurisdiction, notwithstanding any subsequent appeals.

Organization Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of the individual reporting the Sentinel Event*

First NameLast Name

Title*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Description of Sentinel Event*

Date the Sentinel Event occurred*

Date

DirectTrust Accreditation impact(s): Are there considerations that could materially and adversely affect the Organization’s compliance with the Accreditation Criteria (e.g., changes in key executive management in a small Organization or release of a press announcement in a public Organization)?*

Other factual information DirectTrust should consider

Has the Sentinel Event resulted in non-conformity with the Accreditation Criteria? If so, please provide a proposed plan to restore conformity (i.e., an explanation in reasonable detail of how the Organization will promptly reestablish conformity with all applicable Accreditation Criteria). *

Appropriate documentation should be submitted along with the disclosures (e.g., press releases, etc).

Recovery Plans: *

Please verify that you are human*