712 N 2nd Street, Suite 300

St. Louis, MO 63102
v (314) 655-7700 f (314) 655-7701

Preliminary Network Survey Form
Contact
Company
Address
Email

Date: ____________

_________________________________________________
_________________________________________________
_________________________________________________
______________________Phone______________Fax______________

What is your current type of Internet connection & speed? ________________________
If your have a DSL or dial-up connection, is it used by more than 1 computer?
No______
How Many? _____________
What is primary function of your connection? Circle all that apply.
Email & Web Browsing
Hosting of web site
Connection to remote LAN

Other

What type of network do you currently operate?
Windows 95/98/NT/2000/2003/XP)_____Novell______Unix/Linux______AS400_____Apple/Mac_____
How many computers are on the network currently? And estimated in next year?
2-5____6-10_____11-25____25-50______50-100____More than 100_____Next Year__________
What types of computers are using the network?
IBM Compatible
Apple/Mac
Both

Other_______

What protocols are being used on your Local Area Network?
TCP/IP____IPX/SPX Apple Talk
NetBEUI
SNA

Other_______

What Internet services does your organization host? What Platform_____________________
None Web Server
Email / Exchange Server
FTP Server
DNS Server
Database / Application Server
Do you have a Firewall in place? No? Yes? What type?
Microsoft Proxy Server Checkpoint Borderware Secure Computing Cisco Pix
Netware Border Manager Linux/Unix Other_______________________________________
Are you using Network Address Translation (NAT)?

No?

Yes?

Does you currently DHCP? NO Yes If yes, please, complete the following:
Server based DHCP Scope from ______________to__________ Subnet____________________
Router based DHCP Scope from______________ to__________ Subnet____________________
What router/modems or networking equipment exists on your network? ______________________
Is your network segmented? Yes? No?
Do you share a data / phone connection (channelized T-1) No __ Yes __ Lines ___ Bandwidth _______
How many spaces are available on your hubs for new connections? __________

Steve Bloemer
Account Executive
Network Services Division
v (314) 655-7700 f (314) 655-7701 c (314) 443-7657
-1-

Preliminary Network Survey Form

712 N 2nd Street, Suite 300
St. Louis, MO 63102
v (314) 655-7700 f (314) 655-7701

Do multiple LAN segments share your Internet connection either locally or externally? No? Yes?
If yes, please describe___________________________________________
Where is the location of your DMARC? __________________________________
Who performs network maintenance now? Internal staff Vendor Volunteer Owner Other
Do you have a network map? Yes?

No?

Do you have a scheduled maintenance plan in place? Yes ? No? Internal? Vendor contracted?
Is your network remotely monitored? Yes? No? Where? ______________
Do you routinely backup your network? Yes? No?
How often? ____________ Internally? Remotely? Where to? ____________________
Has your network ever been tested by a 3rd party for security loopholes? Yes?

No?

Have you ever had a network inventory performed for insurance purposes? Yes? No?
Do you monitor or filter Internet activity on your network? Yes? No?
Does your firm receive excessive email spam? Yes? No?
Do you have concerns about viruses or other malware? Yes?

No?

Type of phone system in place? _______________ Vendor? _________________
PBX?
Key System?
VoIP?
Hunt lines? ____ Flat lines? ____ DIDs ___ DODs ____
Smart trunk? _____ Super Trunk? _____ SIP Trunk? _____
Other pertinent network information:

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Current IT support contact information
Name _______________________ Title
Phone _______________________ Email

____________________________________
____________________________________

Steve Bloemer
Account Executive
Network Services Division
v (314) 655-7700 f (314) 655-7701 c (314) 443-7657
-2-