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["図書・機器等利用申込書"]
[]
[]
[]
[]
[]
[]
["事業場名"]
[{"$nulls":25},"連絡事務所",null,null,"貸出処理日　　　　月　　　　日"]
["団 体 名",{"$nulls":24},"記入欄",null,null,"返却処理日　　　　月　　　　日"]
[]
["所 在 地"]
[{"$nulls":4},"　〒",{"$nulls":19},"主　　　な　　　　　事業内容"]
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[]
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[{"$nulls":4}," TEL",{"$nulls":9},"FAX",{"$nulls":9},"従業員数",{"$nulls":9},"名"]
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["担 当 者",null,null,null,"所属部署"]
[{"$nulls":22},"※ いずれかに○印をお願いします。"]
[]
[{"$nulls":22},"１．産業医",{"$nulls":7},"５．衛生管理者"]
[{"$nulls":4},"氏名",{"$nulls":17},"２．保健師・看護師",{"$nulls":7},"６．産業保健関係機関"]
[{"$nulls":22},"３．事業主",{"$nulls":7},"７．労働者"]
[{"$nulls":22},"４．労務管理担当者",{"$nulls":7},"８．その他（　　　　　　）"]
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["利用期間",null,null,null,"　　　　　年　　　月　　　日　　　～　　　　年　　　月　　　日",{"$nulls":16},"利用者カード番号"]
[]
[]
["種　　　類",{"$nulls":7},"管　理　番　号",{"$nulls":9},"タ　　　イ　　　ト　　　ル"]
[]
[]
["図書・機器"]
[]
[]
["図書・機器"]
[]
[]
["図書・機器"]
[]
[]
["図書・機器"]
[]
[]
["図書・機器"]
[]
[]
["送付方法（どちらかに必ず表示を）",{"$nulls":12},"　＊宅配（着払い）　　　　　　　＊来所（市内の方にお願い）"]
[]
[]
[]
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["　　＊申込書に必要事項を記載し栃木産業保健総合支援センターにＦＡＸ送信して下さい。"]
[]
[]
[]
[]
[null,"　　栃木産業保健総合支援センター",{"$nulls":10},"〒320-0811　　宇都宮市大通り１－４－２４　ＭＳＣビル４Ｆ"]
[null,null,"　　Tel 028-643-0685     Fax 028-643-0695   ",{"$nulls":13},"E-mail  info@tochigis.johas.go.jp"]
[]
[]
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["    ＊貸出期間　",{"$nulls":5},"図書",{"$nulls":11},"10日以内"]
[]
[{"$nulls":6},"環境測定及び研修機器",{"$nulls":11},"　5日以内"]
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[null,"＊使用料は無料です。但し、送料は利用者がご負担下さい。"]
[]
[null,"＊利用者の便宜を図るため、利用者カードを作成しますので、申込書の記載事項は必ずご記入ください。"]

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