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{"sheet":"表紙","index":0,"n_rows":64,"n_cols":17,"rows_kept":64,"cut":false,"hidden":false,"merged":[[9,2,11,12],[17,2,19,12]]}
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"[2022.03]"]
[null,"事前調査に係る各種文書作成ツール"]
[]
[null,"本ツールは、石綿事前調査結果報告システムよりダウンロードした事前調査結果等報告のCSVファイルから、各種文書を作成します。"]
[null,"操作手順については、本シートの下部の『操作の流れ』をご確認の上ご使用をお願いいたします。"]
[]
[null,"事前調査結果等報告（労働安全衛生法）CSVファイル指定"]
[]
[null,null,"参照先"]
[]
[]
[]
[null,null,"※ファイル名については、システムからダウンロードしたファイル名の変更しないでください。"]
[]
[null,"事前調査結果報告書（大気汚染防止法）CSVファイル指定"]
[]
[null,null,"参照先"]
[]
[]
[]
[null,null,"※ファイル名については、システムからダウンロードしたファイル名の変更しないでください。"]
[]
[]
[]
[]
[]
[]
[null,"注意事項"]
[null,"・本ツールは、石綿事前調査結果報告システムよりダウンロードした事前調査結果等報告CSVファイルから各種文書の作成が行えます。システムからダ"]
[null,"　ウンロードしたCSVファイルは、変更せずにご使用をお願いします。"]
[null,"・「事前調査結果等報告（労働安全衛生法）CSV」と「事前調査結果報告書（大気汚染防止法）CSV」の２ファイルを指定する場合、各CSVファイルで"]
[null,"　重複する項目については、「事前調査結果報告書（大気汚染防止法）CSV」の内容をもとに各種文書を作成します。"]
[null,"・本ツールは複数の報告データに対する文書作成には対応しておりません。CSVファイルに複数の申請情報が含まれる場合は、先頭１件目の申請情報を"]
[null,"　もとに各種文書を作成します。"]
[null,"・同一の申請番号を持つ事前調査結果等報告のCSVを選択してください。"]
[]
[]
[null,"操作の流れ"]
[null,"（１）石綿事前調査結果報告システムより事前調査結果等報告CSVをダウンロードする"]
[null,null,"①石綿事前調査結果報告システムで申請一覧画面を表示します。"]
[null,null,"②申請一覧で該当の申請情報を検索後、ダウンロードボタンをクリックします。"]
[null,null,"③申請出力ダイアログで「フォーマット」項目にはCSVファイルを選択し、「申請区分」項目を選択のうえダウンロードボタンをクリックしてください。"]
[null,null,"④ダウンロードしたＺＩＰファイルをダブルクリックで展開します。"]
[null,null,"※展開されたファイルにＣＳＶファイルが含まれています"]
[null,null,"※ＣＳＶファイルは、申請区分毎に出力されます。"]
[null,null,"　　・事前調査結果等報告（労働安全衛生法）CSV"]
[null,null,"　　・事前調査結果報告書（大気汚染防止法）CSV"]
[]
[null,"（２）本ツールで事前調査結果等報告CSVファイルを選択する"]
[null,null,"①『事前調査結果等報告（労働安全衛生法）CSVファイル指定』項目で『ファイル選択』ボタンを選択してください。"]
[null,null,"②（１）で取得した事前調査結果等報告（労働安全衛生法）CSVファイルを選択して『開く』ボタンを選択してください。"]
[null,null,"③『事前調査結果等報告（大気汚染防止法）CSVファイル指定』項目で『ファイル選択』ボタンを選択してください。"]
[null,null,"④（１）で取得した事前調査結果等報告（大気汚染防止法）CSVファイルを選択して『開く』ボタンを選択してください。"]
[null,null,"⑤②と④で選択したファイルの参照先が表示されるので正しいことをご確認ください。"]
[null,"　　※上記2つのCSVファイルは片方選択、両方選択に関わらず帳票の作成が可能となっております。"]
[]
[null,"（３）『帳票作成』ボタンを選択する"]
[null,null,"以下のシートが作成されます。EXCELの印刷機能で各シートを印刷してください。"]
[null,null,"　　・解体等工事に係る事前調査説明書面"]
[null,null,"　　・特定粉じん排出（石綿除去）等作業の概要"]
[null,null,"　　・特定粉じん排出等作業完了報告書"]
[null,null,"　　・建築物等の解体等の作業に関するお知らせ(石綿無)"]
[null,null,"　　・建築物等の解体等の作業に関するお知らせ(石綿含届出対象)"]
[null,null,"　　・建築物等の解体等の作業に関するお知らせ(石綿含届出非対象)"]

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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,"解体等工事に係る事前調査説明書面"]
[null,"①発注者     ",null,null,"住所"]
[null,null,null,null,"氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"様"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"②元請業者",null,null,null,"住所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（法人にあっては、名称及びその代表者の氏名）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号"]
[null,null,"大気汚染防止法第18条の15第１項に基づき、解体等工事に係る石綿使用の有無に関する事前調査結果について下"]
[null,"記のとおり説明します。"]
[null,"③解体等工事の場所"]
[]
[null,"④解体又は改造・補修着手年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日","延床面積",null,null,null,null,null,null,null,null,null,null,"㎡"]
[null,"⑤解体等工事の種類",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"階数",null,null,null,null,null,null,null,null,null,"階建"]
[null,"⑥建築物等の竣工年（新築工事の着工日記載の年を記載する）",null,null,null,null,null,null,null,null,null,"　　　　　　　年",null,null,null,null,null,null,null,null,"年"]
[null,"⑦建築物等の概要",null,null,null,null,null,null,null,null,null,"□","建築物"]
[null,null,null,null,null,null,null,null,null,null,null,"（　","□","耐火　",null,"□","準耐火　",null,null,"□","その他（",null,null,null,null,null,null,null,null,null,null,null,"）","）"]
[null,null,null,null,null,null,null,null,null,null,null,"（　","□","木造",null,"□","ＲＣ造",null,null,"□","Ｓ造",null,"□","その他（",null,null,null,null,null,null,null,null,"）","）"]
[null,null,null,null,null,null,null,null,null,null,null,"□","その他工作物"]
[null,"⑧事前調査を行った者及び当該\n者が登録規定に基づく講習を\n受講した講習実施機関の名称等",null,null,null,null,null,null,null,null,null,"氏名"]
[null,null,null,null,null,null,null,null,null,null,null,"講習実施機関の名称"]
[null,null,null,null,null,null,null,null,null,null,null,"（　","□","一般",null,"□","特定",null,"□","一戸建て等",null,null,null,"□","その他（",null,null,null,null,null,null,null,"）","）"]
[null,"⑨調査を終了した年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,"⑩調査の方法",null,null,null,null,null,null,null,null,null,"□","書面",null,"□","目視",null,"□","分析",null,"□","その他（",null,null,null,null,null,null,null,null,null,null,null,"）"]
[null,"⑪調査の結果","⑫特定建築材料の有無",null,null,null,null,null,null,null,null,"□","石綿有又は石綿みなし有（詳細は別紙１のとおり）"]
[null,null,null,null,null,null,null,null,null,null,null,"□","石綿無"]
[null,null,"⑬破壊しないと調査できない場所であって、解体等が始まる前に確認できなかった場所"]
[null,"⑭事前調査の掲示","設置予定年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,"設置場所",null,null,null,null,null,null,null,null,"別紙　のとおり"]
[null,"⑮大気汚染防止法に係る作業の\n実施の届出の要否",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□","要",null,null,"□","不要",null,"吹付、断熱材・保温材等レベル１，２建材で石綿有りの場合要とする"]
[null,"備考　１　特定建築材料が有り、特定粉じん排出等作業に該当する場合は別紙１を添付すること。"]
[null,"２　工事中に特定建築材料を見つけた場合、再度説明すること。"]
[]
[null,null,null,null,null,null,null,null,null,null,"元請業者からこの書面の説明を受けました。"]
[null,null,null,null,null,null,null,null,null,null,"⑯","発注者氏名"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"　　　　 　　　 　 　　","　　　　 　　　 　 　　",null,null,"年",null,null,"月",null,null,"日",null,null,null,"　　　　 　　　 　 　　","　　　　 　　　 　 　　"]
[]
[null,null,null,null,null,null,null,null,null,null,"発注者へこの書面の説明を行いました。"]
[null,null,null,null,null,null,null,null,null,null,"⑰","元請業者氏名"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"　　　　 　　　 　 　　","　　　　 　　　 　 　　",null,null,"年",null,null,"月",null,null,"日",null,null,null,"　　　　 　　　 　 　　","　　　　 　　　 　 　　"]
[]
[]
[null,"※　書面の構成等を改変する場合は、○番号の項目を記載した書面とすることが望ましい。"]

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[null,null,"別紙１"]
[null,"特定粉じん排出（石綿除去）等作業の概要"]
[]
[null,"①特定粉じん排出等作業の種類\n\n\n\n\n\n\n",null,null,null,null,null,null,null,null,null,null,null,null,null,"大気汚染防止法施行規則別表第７"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□","１の項",null,null,"建築物等の解体作業のうち、吹付け石綿及び石綿含有"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"断熱材等を除去する作業（次項及び５の項を除く）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□","２の項",null,null,"建築物等の解体作業のうち、石綿含有断熱材等を除去"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"する作業（かき落とし、切断、又は破砕以外の方法で"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定建築材料を除去するもの）（５の項を除く）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□","３の項",null,null,"建築物等の解体等作業のうち、石綿含有仕上塗材を"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"除去する作業（５の項を除く）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□","４の項",null,null,"建築物等の解体等作業のうち、石綿含有成形板等を"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"除去する作業（１から３の項、事項を除く）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□","５の項",null,null,"特定建築材料の事前除去が著しく困難な解体作業"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"□","６の項",null,null,"建築物等の改造・補修作業のうち、吹付け石綿及び"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"石綿含有断熱材等に係る作業"]
[null,"②特定粉じん排出等作業の実施の期間",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"自",null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"至",null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,"③特定粉じん排出等作業の対象となる建築物等\nの部分における特定建築材料等の種類並びに\nその使用箇所及び使用面積",null,null,null,null,null,null,null,null,null,null,null,null,null,1,null,"吹付け石綿",null,null,"（",null,null,null,"、",null,null,null,"㎡","）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,2,null,"石綿を含有する保温材",null,null,null,null,null,"（",null,null,null,"、",null,null,null,"㎡","）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3,null,"石綿を含有する耐火被覆材",null,null,null,null,null,null,"（",null,null,null,"、",null,null,null,"㎡","）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,4,null,"石綿を含有する断熱材",null,null,null,null,null,"（",null,null,null,"、",null,null,null,"㎡","）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,5,null,"石綿を含有する仕上塗材",null,null,null,null,null,"（",null,null,null,"、",null,null,null,"㎡","）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,6,null,"石綿を含有する成形板等",null,null,null,null,null,"（",null,null,null,"、",null,null,null,"㎡","）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"詳細は別紙　のとおり"]
[null,"④特定粉じん排出等作業の方法",null,null,null,null,null,null,null,null,null,null,null,null,null,"□","除去",null,null,"□","囲い込み",null,null,null,"□","封じ込め",null,null,null,"□","その他"]
[null,"⑤特定粉じん排出等作業の方法が法第18条の19\n各号に掲げる措置を当該各号に定める方法によ\nり行うものでないときは、その理由",null,null,null,null,null,null,null,null,null,null,null,null,null,"―"]
[null,"⑥特定粉じん排出等作業の対象となる建築物等\nの配置図及び付近の状況",null,null,null,null,null,null,null,null,null,null,null,null,null,"別紙　のとおり"]
[null,"⑦特定粉じん排出等作業の工程を明示した特定\n工事の工程の概要",null,null,null,null,null,null,null,null,null,null,null,null,null,"別紙　のとおり"]
[null,"⑧作業の掲示","設置予定年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,"設置場所",null,null,null,null,null,null,null,null,null,null,null,null,"別紙　のとおり"]
[null,"⑨特定工事の元請業者の現場責任者の氏名及び\n連絡場所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号　"]
[null,"⑩下請負人が特定粉じん排出等作業を実施する\n場合の当該下請負人の現場責任者の氏名及び\n連絡場所"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号　"]
[null,"※　書面の構成等を改変する場合は、○番号の項目を記載した書面とすることが望ましい。"]
[null,"備考　１　解体等工事が特定粉じん排出等作業（石綿排出等作業）に該当する場合に作成すること。"]
[null,"２　特定粉じん排出等作業（石綿排出等作業）の対象となる建築物等の配置図、付近の状況、特定粉じん排"]
[null,"出等作業（石綿排出等作業）工程を明示した特定工事（特定排出等工事）の工程の概要については、計画し"]
[null,"ている作業方法等がわかるものを添付すること（作業工程を示す日程表、図面等）。"]

{"sheet":"特定粉じん排出等作業完了報告書","index":3,"n_rows":55,"n_cols":33,"rows_kept":55,"cut":false,"hidden":true,"merged":[[41,3,41,6],[28,4,28,32],[29,4,29,5],[30,3,30,6],[31,4,31,28],[51,14,51,15],[54,1,54,33],[42,4,42,14],[43,3,43,15],[44,4,44,22],[47,17,47,25],[48,18,48,21],[48,22,48,31],[40,1,40,2],[40,3,40,6],[27,3,27,6],[21,3,21,6],[22,4,22,32],[23,4,23,32],[24,4,24,5],[32,3,32,30],[33,4,33,32],[36,1,36,2],[37,3,37,6],[38,4,38,19],[26,1,26,2],[26,3,26,16],[8,22,8,25],[8,26,8,32],[10,1,10,32],[11,1,11,9],[13,1,13,2],[13,3,13,11],[14,3,14,11],[16,4,16,26],[17,3,17,9],[19,4,19,32],[20,4,20,14],[15,3,15,32],[18,3,18,32],[1,1,1,33],[3,24,3,25],[5,3,5,9],[7,18,7,21],[7,22,7,25],[7,26,7,32]]}
[]
[null,"特定粉じん排出等作業完了報告書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,"（発注者）"]
[null,null,null,null,null,null,null,null,null,null,"様"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（元請業者）",null,null,null,"法人名　"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"代表者氏名"]
[]
[null,"ご依頼のありました特定粉じん排出等作業について完了したので、大気汚染防止法第18条の23"]
[null,"に基づき報告いたします。"]
[]
[null,"１.",null,"特定粉じん排出等作業の概要"]
[null,null,"・","対象建築物の名称及び所在地"]
[]
[null,null,null,"※","対象建築物の名称（個人宅の場合は○○様住宅）及び所在地住所を記入する。"]
[null,null,"・","除去等作業を行った者"]
[]
[null,null,null,"※","元請業者が行った場合は「報告者と同じ」と記入、下請負人が行った場合は氏名（法人の場合は"]
[null,null,null,null,"法人名及び代表者氏名）を記入する。"]
[null,null,"・","作業の概要"]
[null,null,null,"※","作業の実施期間、特定粉じん排出等作業の種類、特定建築材料の種類、使用箇所、使用面積、除"]
[null,null,null,null,"去方法等、作業計画に記載した内容と実際に行った内容について簡潔に記入、別紙に記入しても"]
[null,null,null,null,"よい。"]
[]
[null,"２.",null,"石綿含有建材の取り残しがないこと等の確認"]
[null,null,"・","確認年月日"]
[null,null,null,"※","石綿含有建材の取り残しがないこと等を確認した年月日を記入する（複数日の場合は期間を記"]
[null,null,null,null,"入）。"]
[null,null,"・","確認者の氏名"]
[null,null,null,"※","確認を行った者の氏名（法人に所属している場合は氏名のほか法人名）を記入する。"]
[null,null,"・","確認者が登録規定に基づく講習又は石綿作業主任者技能講習を受講した講習実施機関の名称等"]
[null,null,null,"※","受講した講習実施機関の名称（一般社団法人日本アスベスト調査診断協会に登録された者につ"]
[null,null,null,null,"いてはその旨）を記入する。"]
[]
[null,"３.",null,"特定粉じん排出等作業の完了"]
[null,null,"・","完了年月日"]
[null,null,null,"※","特定粉じん排出等作業が完了した年月日を記入する。"]
[]
[null,"４.",null,"申し送り事項"]
[null,null,"・","異常時の対応"]
[null,null,null,"※","異常があった場合の対応を記入する。"]
[null,null,"・","計画と異なる対応を行った場合はその措置内容"]
[null,null,null,"※","計画と異なる対応を行った場合はその措置内容を記入する。"]
[]
[]
[null,"　　　　　　　　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"この書面の説明を受けました。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"発注者氏名"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"　　　　 　　　 　 　　","　　　　 　　　 　 　　",null,null,"年",null,null,"月",null,null,"日",null,null,null,"　　　　 　　　 　 　　","　　　　 　　　 　 　　"]
[]
[]
[null,"図4.15.12　発注者への報告様式例"]

{"sheet":"建築物等の解体等の作業に関するお知らせ(石綿無)","index":4,"n_rows":36,"n_cols":38,"rows_kept":36,"cut":false,"hidden":true,"merged":[[23,28,23,29],[23,30,23,42],[24,28,24,42],[25,29,25,42],[35,1,35,43],[26,28,26,29],[26,30,26,34],[26,35,26,38],[26,39,26,42],[27,28,27,29],[27,30,27,42],[29,28,29,42],[30,28,30,42],[31,28,31,42],[32,28,32,42],[33,28,33,42],[21,29,21,42],[22,28,22,30],[22,34,22,36],[22,31,22,33],[22,40,22,42],[22,37,22,39],[18,2,18,27],[18,28,18,42],[19,2,19,27],[19,28,19,32],[20,2,20,27],[20,28,20,42],[15,2,15,27],[15,28,15,33],[15,34,15,42],[16,2,16,27],[17,2,17,27],[10,28,10,42],[11,2,11,5],[11,6,11,27],[11,28,11,42],[14,2,14,27],[14,28,14,33],[14,34,14,42],[1,2,1,41],[3,3,3,40],[4,3,4,40],[6,2,6,6],[6,8,6,42],[7,2,7,18],[7,19,7,20],[7,28,7,42],[21,2,33,27],[9,28,9,42],[12,6,12,27],[12,28,13,42],[13,2,13,5],[13,6,13,27],[8,2,8,18],[8,19,8,20],[8,28,8,42],[9,2,9,7],[9,9,9,10],[9,19,9,20],[10,2,10,27]]}
[null,null,"石綿使用なし記入例　※掲示サイズは（横420mm以上、縦297mm以上）"]
[null,null,"建築物等の解体等の作業に関するお知らせ"]
[]
[null,null,null,"本工事は、石綿障害予防規則第4条の2及び大気汚染防止法第18条の15第6項の規定による事前調査結果の報告を行っております。注）"]
[null,null,null,"大気汚染防止法、労働安全衛生法、石綿障害予防規則及び条例等に基づく調査結果をお知らせします。"]
[]
[null,null,"事業場の名称",null,null,null,null,"："]
[null,null,"調査終了年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日","元請業者（解体等工事の施工者かつ調査者）"]
[null,null,"看 板 表 示 日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日","氏名又は名称(法人にあっては代表者の氏名)"]
[null,null,"解体等工事期間 ",null,null,null,null,null,"： ","令和",null,null,null,"年",null,"月",null,"日","～","令和",null,null,null,"年",null,"月",null,"日"]
[null,null,"調査方法の概要（調査箇所）"]
[null,null,"【調査方法】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[null,null,null,null,null,null,"※建物の着工日で石綿含有なしを判断した場合は、書面調査のみとなる"]
[null,null,"【調査箇所】"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"現場責任者氏名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡場所TEL"]
[]
[null,null,"調査結果の概要(部分と石綿含有建材（特定建築材料）の種類、判断根拠）"]
[null,null,"石綿は使用されていませんでした。（特定工事に該当しません）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査を行った者(分析等の実施者)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名又は名称及び住所"]
[null,null,"【石綿含有なし】○数字は右下欄の「その他の事項」を参照",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事前調査・試料採取を実施した者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"①"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,"会員番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所："]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"分析を実施した者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,null,null,"登録番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所："]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他事項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査結果の概要に示す「石綿含有なし」に記載された○数字は、以"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下の判断根拠を表す"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"①目視　②設計図書　③分析　④材料製造者による証明"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤材料の製造年月日"]
[]
[null,"注）工事に係る部分の床面積の合計が80m2以上の建築物の解体工事、請負金額100万円以上の建築物の改修等工事等の場合"]

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[null,"石綿含有吹付け材、石綿含有保温材等の除去等を含む作業（届出対象）記入例　※掲示サイズは（横420mm以上、縦297mm以上）"]
[null,"建築物等の解体等の作業に関するお知らせ"]
[null,null,"本工事は、石綿障害予防規則第4条の2及び大気汚染防止法第18条の15第6項の規定による事前調査結果の報告注1）、労働安全衛生法第88条第3項（労働"]
[null,null,"安全衛生規則第90条第五号の二）の規定による計画の届出及び大気汚染防止法第18条の17第1項の規定による作業実施の届出を行っております。"]
[null,null,"石綿障害予防規則第3条第8項及び大気汚染防止法第18条の15第5項及び同法施行規則第16条の4第二号の規定により、解体等の作業及び建築物の"]
[null,null,"特定粉じん排出等作業について以下のとおり、お知らせします。"]
[null,null,"事業場の名称",null,null,null,null,"："]
[null,null,"届出先及び",null,null,null,null,null,null,null,null,null,"労働基準監督署",null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日","発注者または自主施工者"]
[null,null,"届出年月日",null,null,null,null,null,null,null,null,null,"都・道・府・県",null,null,null,null,null,null,"市・区",null,"令和",null,null,null,"年",null,"月",null,"日","氏名又は名称(法人にあっては代表者の氏名)"]
[null,null,"調査終了年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日"]
[null,null,"看 板 表 示 日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日"]
[null,null,"解 体 等 工 事 期 間",null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日","～","令和",null,null,null,"年",null,"月",null,"日","住所"]
[null,null,"石綿除去（特定粉じん排出）作業等の作業期間",null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日","～","令和",null,null,null,"年",null,"月",null,"日"]
[null,null,"調査方法の概要（調査箇所）"]
[null,null,"【調査方法】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"元請業者(工事の施工者かつ調査者)"]
[null,null,"（石綿無しと判断した根拠のみを転載しています。実際の調査方法として十分か確認の上、必要に応じ追記してください）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名又は名称(法人にあっては代表者の氏名)"]
[null,null,"【調査箇所】 "]
[null,null,"※改修等の場合は、改修等を実施するために調査した箇所を記載する。"]
[null,null,"（例）１階機械室（改修等工事対象場所）"]
[null,null,"調査結果の概要(部分と石綿含有建材（特定建築材料）の種類、判断根拠）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[null,null,"【石綿含有あり】"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"現場責任者氏名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡場所TEL"]
[null,null,"【石綿含有なし】○数字は右下欄の「その他の事項」を参照",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"を石綿作業主任者に選任しています。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査を行った者(分析等の実施者)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名又は名称及び住所"]
[]
[null,null,"石綿除去等作業（特定粉じん排出等作業）の方法",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事前調査・試料採取を実施した者"]
[null,null,"石綿含有建材（特定建築材料）の処理方法",null,null,null,null,null,null,null,"□","除去",null,null,"□","封じ込め",null,null,null,"□","囲い込み",null,null,null,"□","その他",null,null,null,null,"①"]
[null,null,"集じん・排気装置","機種・型式・設置数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,"登録番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所："]
[null,null,null,"排気能力（㎡/ｍｉｎ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"分析を実施した者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②"]
[null,null,null,"使用するフィルタの種類及びその集じん効果(％)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名",null,null,null,null,null,"登録番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所："]
[null,null,"使用する資材及びその種類",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他事項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査結果の概要に示す「石綿含有なし」に記載された〇数字は、以"]
[null,null,"その他の石綿（特定粉じん）の\n排出又は飛散の抑制方法",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下の判断根拠を表す"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"①目視　②設計図書　③分析　④材料製造者による証明"]
[null,null,"備考：",null,"その他の条例等の届出年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤材料の製造年月日"]
[]
[]
[]
[null,"注１）工事に係る部分の床面積の合計が80m2以上の建築物の解体工事、請負金額100万円以上の建築物の改修等工事等の場合"]
[null,"注2）封じ込め工法や囲い込み工法を行う場合の記載例"]

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[null,"石綿含有成形板等、石綿含有仕上塗材の除去等作業（届出非対象）記入例　※掲示サイズは（横420mm以上、縦297mm以上）"]
[null,"建築物等の解体等の作業に関するお知らせ"]
[null,null,"本工事は、石綿障害予防規則第4条の2及び大気汚染防止法第18条の15第6項の規定による事前調査結果の報告を行っております。注）"]
[null,null,"石綿障害予防規則第3条第8項及び大気汚染防止法第18条の15第5項及び同法施行規則第16条の4第二号の規定により、解体等の作業及び建築物の"]
[null,null,"特定粉じん排出等作業について以下のとおり、お知らせします。"]
[null,null,"事業場の名称",null,null,null,null,"："]
[null,null,"調査終了年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,null,"月",null,null,"日",null,"発注者または自主施工者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名又は名称(法人にあっては代表者の氏名)"]
[null,null,"看 板 表 示 日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,null,"月",null,null,"日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[null,null,"解 体 等 工 事 期 間",null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日","～","令和",null,null,null,"年",null,"月",null,"日"]
[null,null,"石綿除去（特定粉じん排出）作業等の作業期間",null,null,null,null,null,null,null,null,"令和",null,null,null,"年",null,"月",null,"日","～","令和",null,null,null,"年",null,"月",null,"日"]
[null,null,"調査方法の概要（調査箇所）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"元請業者(工事の施工者かつ調査者)"]
[null,null,"【調査方法】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名又は名称(法人にあっては代表者の氏名)"]
[null,null,"【調査箇所】 "]
[]
[null,null,"調査結果の概要(部分と石綿含有建材（特定建築材料）の種類、判断根拠）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
[null,null,"【石綿含有あり】"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"現場責任者氏名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡場所TEL"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"を石綿作業主任者に選任しています。"]
[null,null,"【石綿含有なし】○数字は右下欄の「その他の事項」を参照",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査を行った者(分析等の実施者)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名又は名称及び住所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"事前調査・試料採取を実施した者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"①"]
[null,null,"石綿除去等作業（特定粉じん排出等作業）の方法",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名",null,null,null,null,"登録番号"]
[null,null,"石綿含有建材（特定建築材料）の処理方法",null,null,null,null,null,null,null,"□","除去",null,null,"□","封じ込め",null,null,null,"□","囲い込み",null,null,null,"□","その他",null,null,null,null,"住所："]
[null,null,"特定粉じんの排出又は飛散の抑制方法",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"分析を実施した者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"②"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　氏名",null,null,null,null,null,"登録番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所："]
[]
[]
[]
[null,null,"使用する資材及びその種類",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他事項"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"調査結果の概要に示す「石綿含有なし」に記載された〇数字は、以"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下の判断根拠を表す"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"①目視　②設計図書　③分析　④材料製造者による証明"]
[null,null,"備考：",null,"その他の条例等の届出年月日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑤材料の製造年月日"]
[]
[]
[null,"注）工事に係る部分の床面積の合計が80m2以上の建築物の解体工事、請負金額100万円以上の建築物の改修等工事等の場合"]