Firewall Rule Request-Report Template

Customer Information
Customer Name Firewall Authorization Contact Name
Agency and Division Names Firewall Authorization Contact Phone #
Date of Request Firewall Authorization Email Address
Requested Completion Date

Rule Table
Source(s) Destination(s) Service(s)
Firewall Hostname NAT'd Address IP Address Firewall Hostname IP Address NAT'd Address Protocol Port #

WaTech Use Only

INFRA Ticket # Implemented by:

Authorized by: Host Based:

Checked for Implementation

authorization: Date:

NOTE: Completed form must be sent to ServiceDesk@watech.wa.gov by identified purchaser/signature authority or designee. Request will be processed ONLY if submitted by Customer identified purchaser/signature authority or their designee. Service Desk: please send this ticke
tion Contact Name
tion Contact Phone #
tion Email Address

)
Purpose
Description

k: please send this ticket to the WaTech Firewall Group.

 Firewall Information

Sample Template
Rule Table
Source(s) Destination(s) Service(s)
Hostname IP Address NAT'd Address Hostname IP Address NAT'd Address Port Number
SWSAPHUBDEV xxx.xxx.xxx.xxx Any Any 3061,
80 3071,
3076, 3081,
SWSAPHUBPROD2 xxx.xxx.xxx.xxx DISV1 xxx.xxx.xx.xx 3091, 3096, 3097

Useful Port Information

Port Name Port
53, 88,Number
123, 135, 138, 139, Protocol
AD 389, 445, 636, 3268, 3269, TCP
FTP 20, 21 TCP
HTTP, HTTPS 80, 443 TCP
ICMP NA
LDAP 389 TCP/UDP
MSSQL DB Administration 1433 TCP
MySQL Server 3306 TCP
NetBIOS 137-139 TCP/UDP
NFS 2049 TCP/UDP
NTP 123 UDP
Oracle DB 1521 TCP/UDP
RDP 3389 TCP
SHH 22 TCP/UDP
SMTP 25 TCP
SNMP 161, 162 TCP/UDP
TSM 1500, 1501 TCP/UDP
Vmware VM console 443, 903 TCP
Deep Security Agent 4118, 4120 TCP/UDP
 Service(s) Firewall Purpose
Protocol Description
TCP HTTP SWS connect web server
TCP EntireX SWS connect web server