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Subject Access Request Management Form

General Information

SAR Reference Code

Date Received

*

Time Received

*

Received By

*

Method of Receipt

*

A

Email

B

Website

C

Letter

D

In person

E

Other

Requester Details

Full Name

*

Email Address

*

Telephone Number

*

Address

*

Is requester asking for their own data?

*

A

Yes

B

No

Person represented

*

Relationship/Authority

*

Evidence of authority received?

*

A

Yes

B

No

Identity Verification Status

*

Request Details

Information Requested

*

Date Range Requested

*

Incident References if known

*

PRF/Medical Records Requested?

*

A

Yes

B

No

Security Reports Requested?

*

A

Yes

B

No

BWV/CCTV Requested?

*

A

Yes

B

No

Other Records Requested

*

Processing

Systems Searched

*

Search Completed?

*

A

Yes

B

No

Records Located

*

Third-Party Information Present?

*

A

Yes

B

No

Redaction Required?

*

A

Yes

B

No

Exemption/Restriction Considered?

*

A

Yes

B

No

Reviewed by and Explanation

*

Response Deadline

*

Extension required/considered?

*

A

Yes

B

No

Response Issued?

*

A

Yes

B

No

Response Date

*

Response Method

*

Response Description of information supplied

*

Case Closed?

*

A

Yes

B

No

Reviewer Signature

*

Signature