Public Utility Security Planning and Readiness Self-Certification Form
(Note: Please do not submit actual Physical, Cyber, Emergency Response or Business
Questions concerning this form should be directed to the Bureau of Technical Utility
Services at 717-783-6159.
Utility / Industry Type
PUC Utility Code
1. Does your company have a physical security plan?
2. Has your physical security plan been reviewed in the last year and updated as
3. Is your physical security plan tested annually?
4. Does your company have a cyber security plan?
5. Has your cyber security plan been reviewed in the last year and updated as needed?
6. Is your cyber security plan tested annually?
7. Does your company have an emergency response plan?
8. Has your emergency response plan been reviewed in the last year and updated as
9. Is your emergency response plan tested annually?
10. Does your company have a business continuity plan?
11. Has your business continuity plan been reviewed in the last year and updated
12. Is your business continuity plan tested annually?
By clicking this checkbox, I aver that I,
[name], am authorized to complete this form on behalf of
[name of Utility] being the
[position] of this Utilty/corporation/partnership/proprietorship
and verify that the facts set forth above are true and correct to the best of my knowledge, information and belief. This verification is made pursuant to 52 Pa. Code § 1.36 and that
statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 (relation to unsworn falsification to authorities).
Rev. Date: 12/2012