Assessment Information Form 1. Company/Organization name: 2. Physical address: 3. Mailing address: 4. Phone number: 5. Fax number: 6. Email address: 7. Website address: 8. Owner, President or CEO name: 8.a Contact phone number: 8.b Email address: 9. Office, Business or Operations Manager name: 9.a Contact phone number: 8.b Email address: Name First Last b. Title: c. Contact phone number: d. Email address: 11. Who is your Internet service provider? 12. Do you have existing IT support? Yes No a. If yes, is it provided by internal staff, an external support provider, or both? Internal External Both a. How many desktops does your company use? i. What is their average age range? Less than one year1-3 years3-5 years5 or more years b. How many laptops does your company use? i. What is their average age range? Less than one year1-3 years3-5 years5 or more years ii. Are they used for remote network access? Yes No c. How many employees use their mobile devices at work? i. Do they access private records through these devices? Yes No ii. Do they work remotely on these devices? Yes No d. How many printers does your company have? e. Who is your phone service provider? i. Are you in contract with this provider? Yes No ii. How many desktop phones does your company use? f. Does your company or building have an alarm system? Yes No i. If yes, who is the alarm monitoring provider? g. Does your company have access controls on doors? Yes No h. Does your company or building have security cameras? Yes No i. If yes, how many? i. Does your company use any television and/or commercial free music services? (i.e. DIRECTV, Verizon FiOS, SiriusXM) Yes No i. If yes, who is your television service provider? ii. How many televisions do you have? iii. If yes, who provides your commercial free music services? j. Does your company use Wi-Fi? Yes No i. Is Wi-Fi used internally for the business? Yes No ii. Do you provide guest Wi-Fi service? Yes No * I understand and agree to the terms and conditions set forth in the Assessment Terms and Conditions and Business Associates Agreement located at www.isnglobal.com/legal. Name This field is for validation purposes and should be left unchanged.