Risk Assessment and Mitigation Tool PCI-DSS-FORM-12-4
Assessment Details Risk Assessment Title
[Short, descriptive title]
Risk Assessment Scope
[Describe the scope of the risk assessment e.g. location, process, assets] Context of Business Impact [Describe the general environment in which the analysis is Analysis carried out and internal and external factors affecting it] Risk Acceptance Criteria Version
[Set out the factors which will make a risk acceptable and therefore not require mitigation] [Start at Version 1]
Dated
[Date the assessment was carried out]
Risk Assessors
[Name and title of person(s) carrying out the risk assessment]
Risk Assessment Participants Approval
[Names and titles of people contributing to the risk assessment] [Name and title of approver]
Date Approved
[Date the assessment was approved]