This form is for the use of UTILITY COMPANIES ONLY.

 

CONFIDENTIAL

Public Utility Security Planning and Readiness Self-Certification Form

(Note: Please do not submit actual Physical, Cyber, Emergency Response or Business Continuity Plans)

Questions concerning this form should be directed to the Bureau of Technical Utility Services at 717-783-6159.

Utility / Industry Type
 
Company Name
 
PUC Utility Code

Year Ended


1. Does your company have a physical security plan?
   
2. Has your physical security plan been reviewed in the last year and updated as needed?
   
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 needed?
   
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 as needed?
   
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