Open Port Scan Checklist Form
Plan, document, and track authorized open port scans on target systems or networks.
Scan Purpose
*
Requester or Team Name
*
Target System or Network Name
*
Target IP Address or Host Range
*
Scheduled Scan Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Scan Method or Tool Used
*
Please Select
Nmap
Masscan
Netcat
Custom Script
Other
Port Scope
*
Please Select
Common Ports (1-1024)
All TCP Ports
All UDP Ports
Custom Range
Authorization Confirmed
*
Yes, authorization has been obtained
No, authorization not yet confirmed
Risk or Impact Notes
Scan Results or Findings
Submit Checklist
Should be Empty: