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[null,"備考１",null,"該当する日（事業開始日）から４週間の状況を記入してください。"]
[null,"備考２",null,"申請する事業・施設に係る従業者全員（管理者含む）について、４週間分の勤務すべき時間数を記入して下さい。夜勤、宿直等については、日ごとの勤務時間を明記した上で、網かけをする等その旨を表示して下さい。"]
[null,"備考３",null,"職種ごとにＡ（常勤・専従）、Ｂ（常勤・兼務）、Ｃ（常勤以外・専従）、Ｄ（常勤以外・兼務）の区分ごとにまとめて記入し、「週平均の勤務時間」については、職種ごとに小計して下さい。"]
[null,"備考４",null,"常勤換算が必要な職種は、職種ごとにＡ～Ｄの「週平均の勤務時間」をすべて足し、常勤の従業者が勤務すべき時間数で除して「常勤換算後の人数」を算出して下さい。なお、Ａ又はＢに該当する場合は、「常勤換算後の人数」欄に「１」を記入してください。"]
[]
[null,"備考５",null,"加算等に係る加配職員については、「加算対象の加配」欄に「加算」と記入してください。"]
[null,"備考６",null,"算出にあたっては、小数点以下第２位を切り捨てて下さい。"]
[null,"備考７",null,"勤務時間数は、休憩時間を除いた実勤務時間を記載して下さい。"]

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["看護職員",{"$nulls":4},"Ａ",null,"■■　■■",{"$nulls":6},8,8,8,8,8,null,null,8,8,8,8,8,null,null,8,8,8,8,8,null,null,8,8,8,8,8,null,160,40]
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[null,"備考１",null,"該当する日（事業開始日）から４週間の状況を記入してください。"]
[null,"備考２",null,"申請する事業・施設に係る従業者全員（管理者含む）について、４週間分の勤務すべき時間数を記入して下さい。夜勤、宿直等については、日ごとの勤務時間を明記した上で、網かけをする等その旨を表示して下さい。"]
[null,"備考３",null,"職種ごとにＡ（常勤・専従）、Ｂ（常勤・兼務）、Ｃ（常勤以外・専従）、Ｄ（常勤以外・兼務）の区分ごとにまとめて記入し、「週平均の勤務時間」については、職種ごとに小計して下さい。"]
[null,"備考４",null,"常勤換算が必要な職種は、職種ごとにＡ～Ｄの「週平均の勤務時間」をすべて足し、常勤の従業者が勤務すべき時間数で除して「常勤換算後の人数」を算出して下さい。なお、Ａ又はＢに該当する場合は、「常勤換算後の人数」欄に「１」を記入してください。"]
[]
[null,"備考５",null,"加算等に係る加配職員については、「加算対象の加配」欄に「加算」と記入してください。"]
[null,"備考６",null,"算出にあたっては、小数点以下第２位を切り捨てて下さい。"]
[null,"備考７",null,"勤務時間数は、休憩時間を除いた実勤務時間を記載して下さい。"]

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[]
["2)","サービス管理責任者養成研修(地域生活（知的･精神）"]
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[]
["3)","サービス管理責任者養成研修（就労）"]
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[]
["備考"]

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[{"$nulls":6},"サービス提供責任者"]
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[{"$nulls":6},"相談支援専門員"]
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["自宅電話番号",{"$nulls":4},"０６",null,null,null,"－","６９４１",null,null,null,"－","××××",null,null,null,"備考"]
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[null,null,null,"年",null,"月～",{"$nulls":4},"年",null,"月"]
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["2)","サービス管理責任者養成研修（介護）"]
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["3)","サービス管理責任者養成研修（就労）"]
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["備考"]

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[]
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["ﾌ ﾘ ｶﾞ ﾅ",{"$nulls":4},"ﾏﾂﾀﾞ   ﾄｵﾙ",{"$nulls":11},"生年月日",null,null,null,"昭和",null,33,"年",1,"月",18,"日（",null,"５１",null,"歳）"]
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["事業所・\n施設の種類",{"$nulls":4},"就労継続支援Ｂ型"]
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["具体的な\n業務の内容"]
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["上記のとおり、",{"$nulls":9},"の経験を有することを証明します。"]
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[null,"平成",null,21,null,"年",4,null,"月",14,null,"日"]
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["（参考様式３）"]
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[]
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["職種",{"$nulls":4},"居宅介護従業者、行動援護従業者"]
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["上記のとおり、",{"$nulls":5},"介護等",null,null,null,"の経験を有することを証明します。"]
[]
[null,"平成",null,19,null,"年",2,null,"月",21,null,"日"]
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["（参考様式４）"]
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[{"$nulls":8},"相談支援従事者研修等受講誓約書"]
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[{"$nulls":15},"主たる事務所\nの所在地",{"$nulls":4},"："]
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[null,"このたびの障害者自立支援法に基づく",{"$nulls":25},"の指定申請に"]
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["研修を修了及び受講したものを配置することができません。"]
[null,"つきましては、下記のとおり研修を受講させ、適正な有資格者を配置することを約束"]
["します。"]
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[null,"記"]
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[null,"１",null,"資格要件を満たしていない職種"]
[null,"２",null,"研修を受講させる者の氏名"]
[null,"３",null,"受講する研修の種類",{"$nulls":12},"１）"]
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[null,"上記のとおり、研修を受講・修了することに同意します。"]
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[{"$nulls":13},"住所"]
[{"$nulls":13},"氏名",{"$nulls":17},"印"]

{"sheet":"参考４研修受講誓約書【記入例】","index":7,"n_rows":29,"n_cols":32,"rows_kept":29,"cut":false,"hidden":false,"merged":[[23,16,23,17],[23,18,23,19],[22,3,22,14],[19,1,19,2],[22,1,22,2],[21,1,21,2],[21,3,21,14],[23,1,23,2],[23,3,23,14],[4,12,6,14],[4,15,4,19],[6,15,6,19],[6,31,6,33],[6,21,6,30],[23,20,23,21],[23,23,23,24],[4,21,4,33],[5,21,5,33],[11,1,11,32],[18,18,18,32],[17,16,17,32],[22,16,22,17],[21,18,21,19],[22,18,22,19],[21,20,21,21],[21,16,21,17],[20,18,20,32],[9,22,9,32],[17,1,17,2],[5,15,5,19],[9,0,9,4],[9,5,9,7],[8,1,8,15],[8,16,8,26],[10,0,10,22],[9,8,9,13],[9,14,9,21],[8,27,8,32],[19,16,19,17],[19,18,19,32],[14,1,14,32],[16,3,16,14],[17,3,17,14],[19,3,19,14],[16,16,16,32],[16,1,16,2],[12,0,12,3],[18,1,18,2],[18,3,18,14],[18,16,18,17],[20,1,20,2],[20,3,20,14],[20,16,20,17],[2,8,2,25],[28,13,28,14],[27,15,27,33],[28,15,28,30],[28,31,28,33],[25,1,25,22],[27,13,27,14],[21,23,21,24],[22,20,22,21],[22,23,22,24]],"flags":["formulas_cached_only"]}
["（参考様式４）"]
[]
[{"$nulls":8},"相談支援従事者研修等受講誓約書"]
[]
[{"$nulls":15},"主たる事務所\nの所在地",{"$nulls":4},"：","大阪市中央区大手前二丁目1番22号　府庁本館ビル"]
[{"$nulls":15},"名　　称",{"$nulls":4},"：","社会福祉法人　大阪府庁福祉会"]
[{"$nulls":15},"代表者の\n職・氏名",{"$nulls":4},"：","理事長　　○○　○○",{"$nulls":9},"印"]
[]
[null,"このたびの障害者自立支援法に基づく",{"$nulls":14},"指定障害福祉サービス事業者",{"$nulls":10},"の指定申請に"]
["際し、当該",{"$nulls":4},"事業所",null,null,"に配置すべき",{"$nulls":5},"サービス管理責任者",{"$nulls":7},"については、その要件である"]
["研修を修了及び受講したものを配置することができません。"]
[null,"つきましては、下記のとおり研修を受講させ、適正な有資格者を配置することを約束"]
["します。"]
[]
[null,"記"]
[]
[null,"１",null,"資格要件を満たしていない職種",{"$nulls":12},"サービス管理責任者"]
[null,"２",null,"研修を受講させる者の氏名",{"$nulls":12},"府庁　花子"]
[null,"３",null,"受講する研修の種類",{"$nulls":12},"１）",null,"サービス管理責任者研修（介護）"]
[{"$nulls":16},"２）"]
[{"$nulls":16},"３）"]
[null,"４",null,"研修を受講・修了する時期",{"$nulls":12},"１）",null,"平成",null,"２０",null,"年","３",null,"月"]
[{"$nulls":16},"２）",null,"平成",null,null,null,"年",null,null,"月"]
[{"$nulls":16},"３）",null,"平成",null,null,null,"年",null,null,"月"]
[]
[null,"上記のとおり、研修を受講・修了することに同意します。"]
[]
[{"$nulls":13},"住所",null,"大阪市中央区大手前△丁目△番△号"]
[{"$nulls":13},"氏名",null,"府庁　花子",{"$nulls":15},"印"]

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["（参考様式５）"]
[{"$nulls":14},"平面図"]
[]
["事業所・施設の名称"]
{"$rows_empty":28}
["備考１　各室の用途及び面積を記載してください。"]
["　　２　当該事業の専用部分と他との共用部分を色分けする等使用関係を分かりやすく表示してください。"]
["　　３　既成の平面図がある場合は、それを添付しても差し支えありません。（ただし、各室の用途、面積及び写真撮影ポイントの記載は必要）"]

{"sheet":"参考５平面図【記入例】","index":9,"n_rows":36,"n_cols":30,"rows_kept":36,"cut":false,"hidden":false,"merged":[[30,0,31,2],[30,3,31,5],[30,6,31,8],[30,9,31,12],[1,14,1,21],[3,0,3,7],[3,8,3,35],[23,1,25,3],[23,4,25,6],[23,7,25,9],[6,17,12,24],[21,17,31,24],[6,9,12,12],[6,1,12,8],[6,29,31,34],[15,0,15,1],[17,15,31,16],[6,13,12,16],[20,7,22,9],[20,10,25,11],[20,1,22,3],[20,4,22,6],[6,25,8,28],[29,25,31,28]],"flags":["formulas_cached_only"]}
["（参考様式５）"]
[{"$nulls":14},"平面図"]
[]
["事業所・施設の名称",{"$nulls":7},"○○○○（申請書に記載したものと同一の事業所名）"]
[]
["○○○ビル○階平面図"]
[null,"更衣室\n（○○．○㎡）",{"$nulls":7},"給湯室\n（○○．○㎡）",null,null,null,"トイレ\n（○○．○㎡）",null,null,null,"相談室\n（○○．○㎡）",{"$nulls":7},"階段室",null,null,null,"（他社）"]
{"$rows_empty":7}
[{"$nulls":8},"(10)"]
["(14)",{"$nulls":9},"(9)",null,null,null,"(8)",{"$nulls":9},"(2)"]
[]
[{"$nulls":15},"カウンター",null,"(3)"]
[]
[]
[null,"サービス提供\n責任者\n（訪問介護）",null,null,"サービス提供\n責任者\n（訪問介護）",null,null,"サービス提供\n責任者\n（訪問介護）",null,null,"管理者\n（訪問介護、居宅介護兼務）"]
[{"$nulls":17},"会議室\n（○○．○㎡）"]
[{"$nulls":27},"(1)"]
[null,"サービス提供\n責任者\n（居宅介護）",null,null,"サービス提供\n責任者\n（居宅介護）",null,null,"サービス提供\n責任者\n（居宅介護）"]
[]
[]
[]
[]
["(13)"]
[{"$nulls":25},"エレベータ"]
["書棚\n（訪問介護）",null,null,"書棚\n（訪問介護）",null,null,"書棚\n（居宅介護）",null,null,"複写機、ファックス"]
[]
[]
["備考１　各室の用途及び面積を記載してください。"]
["　　２　当該事業の専用部分と他との共用部分を色分けする等使用関係を分かりやすく表示してください。"]
["　　３　既成の平面図がある場合は、それを添付しても差し支えありません。（ただし、各室の用途、面積及び写真撮影ポイントの記載は必要）"]

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["（参考様式６）"]
[null,"居室面積等一覧表",{"$nulls":4},"事業所・施設名（",{"$nulls":12},"）"]
[{"$nulls":6},"サービス種類（",{"$nulls":12},"）"]
[]
[]
[null,null,"(",null,null,null,")階","号室","(",null,null,null,")階","号室","(",null,null,null,")階","号室"]
[]
["（居室等）","１室の定員","室数","面　　　　積",null,null,null,"備考","室数","面　　　　積",null,null,null,"備考","室数","面　　　　積",null,null,null,"備考"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
["（居室以外）"]
[{"$nulls":6},"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
[{"$nulls":6},"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
[{"$nulls":6},"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
[{"$nulls":6},"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
[{"$nulls":6},"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
[{"$nulls":6},"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
[{"$nulls":6},"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
[{"$nulls":6},"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
["片廊下の幅",{"$nulls":5},"ｍ",{"$nulls":5},"ｍ",{"$nulls":5},"ｍ"]
["中廊下の幅",{"$nulls":5},"ｍ",{"$nulls":5},"ｍ",{"$nulls":5},"ｍ"]
["共用する施設・事業所名（",{"$nulls":18},"）"]
[]
["備考１","設備基準で定められた部屋について、設置階ごとに記入してください。"]
["２","居室・療養室等については、「１室の定員」ごとに分けて記入してください。また、同じ定員でも、面積の異なる部屋がある場合は、さらにそれぞれの部屋ごとに分けて記入してください。"]
["３","「１人あたりの面積」の算出が必要な設備は、面積欄の（　）内に記入してください。（算出にあたって、小数点以下第２位を切り捨ててください）"]
["４","部屋の種類ごとにまとめて、合計の室数・面積を記入してください。"]
["５","他の事業所又は施設と共用している場合は、「備考欄」に「共用」と記入し、「共用する事業所・施設名」欄に正式名称を記入し、共用先の当該部分の平面図を添付してください。"]
["６","同一の事業所又は施設の他の部屋と兼用している場合は、「備考欄」に「〇〇室と兼用」と記入してください。"]
["７","設置階数が様式の欄を超える場合は、複数枚に分けて記入し、まとめて提出してください。"]

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["（参考様式６）"]
[null,"居室面積等一覧表",{"$nulls":4},"事業所・施設名（",null,null,"大阪府庁障害福祉サービスセンター",{"$nulls":9},"）"]
[{"$nulls":6},"サービス種類（",null,null,"指定障害者支援施設",{"$nulls":9},"）"]
[]
[]
[null,null,"(","１",null,null,")階","号室","(","２",null,null,")階","号室","(",null,null,null,")階","号室"]
[]
["（居室等）","１室の定員","室数","面　　　　積",null,null,null,"備考","室数","面　　　　積",null,null,null,"備考","室数","面　　　　積",null,null,null,"備考"]
["居室",1,10,99,"(",9.9,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
["居室",1,null,null,"(",null,"㎡)",null,10,99,"(",9.9,"㎡)",null,null,null,"(",null,"㎡)"]
["居室",2,null,null,"(",null,"㎡)",null,6,72,"(",12,"㎡)",null,null,null,"(",null,"㎡)"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
[{"$nulls":4},"(",null,"㎡)",null,null,null,"(",null,"㎡)",null,null,null,"(",null,"㎡)"]
["（居室以外）"]
["作業・訓練室１",null,1,150,null,null,"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
["作業・訓練室２",null,1,100,null,null,"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
["作業・訓練室３",{"$nulls":5},"㎡",null,1,100,null,null,"㎡",{"$nulls":5},"㎡"]
["浴室",null,1,20,null,null,"㎡",null,1,20,null,null,"㎡",{"$nulls":5},"㎡"]
["便所",null,2,20,null,null,"㎡",null,2,20,null,null,"㎡",{"$nulls":5},"㎡"]
["食堂",null,1,70,null,null,"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
["相談室",null,1,10,null,null,"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
["事務室",null,1,10,null,null,"㎡",{"$nulls":5},"㎡",{"$nulls":5},"㎡"]
["片廊下の幅",null,1.5,null,null,null,"ｍ",{"$nulls":5},"ｍ",{"$nulls":5},"ｍ"]
["中廊下の幅",null,1.8,null,null,null,"ｍ",{"$nulls":5},"ｍ",{"$nulls":5},"ｍ"]
["共用する施設・事業所名（",{"$nulls":18},"）"]
[]
["備考１","設備基準で定められた部屋について、設置階ごとに記入してください。"]
["２","居室・療養室等については、「１室の定員」ごとに分けて記入してください。また、同じ定員でも、面積の異なる部屋がある場合は、さらにそれぞれの部屋ごとに分けて記入してください。"]
["３","「１人あたりの面積」の算出が必要な設備は、面積欄の（　）内に記入してください。（算出にあたって、小数点以下第２位を切り捨ててください）"]
["４","部屋の種類ごとにまとめて、合計の室数・面積を記入してください。"]
["５","他の事業所又は施設と共用している場合は、「備考欄」に「共用」と記入し、「共用する事業所・施設名」欄に正式名称を記入し、共用先の当該部分の平面図を添付してください。"]
["６","同一の事業所又は施設の他の部屋と兼用している場合は、「備考欄」に「〇〇室と兼用」と記入してください。"]
["７","設置階数が様式の欄を超える場合は、複数枚に分けて記入し、まとめて提出してください。"]

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["（参考様式７）"]
[{"$nulls":5},"設備・備品一覧表"]
[{"$nulls":6},"事業所・施設の名称（",{"$nulls":17},"）"]
[{"$nulls":6},"サービスの種類（",{"$nulls":17},"）"]
["設備等の種類",{"$nulls":6},"設備基準上適合すべき項目についての状況",{"$nulls":13},"適合の可否"]
[]
["サービス提供上配慮すべき設備の概要"]
{"$rows_empty":10}
["非常災害設備等"]
["室名",{"$nulls":6},"備品の品名及び数量"]
{"$rows_empty":11}
["備考１　申請するサービス種類に関して、基準省令で定められた設備基準上適合すべき項目のうち、\n　　　「居室面積等一覧表」に記載した設備について記載してください。"]
["　　２　必要に応じて写真等を添付し、その旨を合わせて記載してください。"]
["　　３　「適合の可否」欄には、何も記載しないでください。"]

{"sheet":"参考７設備・備品一覧表【記入例】","index":13,"n_rows":33,"n_cols":25,"rows_kept":33,"cut":false,"hidden":false,"merged":[[1,5,1,19],[29,21,29,24],[28,21,28,24],[26,21,26,24],[27,21,27,24],[24,21,24,24],[25,21,25,24],[23,21,23,24],[21,21,21,24],[22,21,22,24],[11,21,11,24],[12,21,12,24],[18,21,19,24],[20,21,20,24],[15,21,15,24],[16,21,16,24],[17,21,17,24],[29,7,29,20],[22,7,22,20],[24,7,24,20],[26,7,26,20],[27,7,27,20],[28,7,28,20],[25,7,25,20],[25,0,25,6],[23,0,23,6],[24,0,24,6],[6,21,6,24],[7,21,7,24],[8,21,8,24],[13,21,13,24],[14,21,14,24],[9,21,9,24],[10,21,10,24],[15,0,15,6],[16,0,16,6],[17,0,17,6],[23,7,23,20],[20,7,20,20],[21,7,21,20],[14,0,14,6],[8,7,8,20],[14,7,14,20],[21,0,21,6],[10,7,10,20],[11,7,11,20],[11,0,11,6],[12,0,12,6],[13,0,13,6],[20,0,20,6],[6,0,7,6],[9,7,9,20],[17,7,17,20],[15,7,15,20],[16,7,16,20],[12,7,12,20],[13,7,13,20],[8,0,8,6],[9,0,9,6],[10,0,10,6],[30,0,30,24],[31,0,31,24],[32,0,32,24],[18,0,19,6],[18,7,19,20],[22,0,22,6],[29,0,29,6],[26,0,26,6],[27,0,27,6],[28,0,28,6],[2,6,2,11],[3,6,3,11],[3,12,3,23],[4,21,5,24],[4,0,5,6],[4,7,5,20],[2,12,2,23]],"flags":["formulas_cached_only"]}
["（参考様式７）"]
[{"$nulls":5},"設備・備品一覧表"]
[{"$nulls":6},"事業所・施設の名称（",{"$nulls":5},"大阪府庁障害福祉サービスセンター",{"$nulls":11},"）"]
[{"$nulls":6},"サービスの種類（",{"$nulls":5},"障害者支援施設",{"$nulls":11},"）"]
["設備等の種類",{"$nulls":6},"設備基準上適合すべき項目についての状況",{"$nulls":13},"適合の可否"]
[]
["サービス提供上配慮すべき設備の概要"]
[]
["・相談室",{"$nulls":6},"利用者のプライバシーに配慮し、独立した部屋を設けている"]
["・作業・訓練室１",{"$nulls":6},"訓練に必要な機械器具等を備えている"]
["・作業・訓練室２",{"$nulls":6},"訓練に必要な機械器具等を備えている"]
["・作業・訓練室３",{"$nulls":6},"作業に必要な機械器具等を備えている"]
["・食堂",{"$nulls":6},"食事の提供に必要な備品を備えている"]
["・浴室",{"$nulls":6},"利用者の特性に応じたものを備えている"]
["・居室",{"$nulls":6},"利用者のプライバシーに配慮し、全ての居室を個室としている"]
[]
[]
["非常災害設備等",{"$nulls":6},"スプリンクラー、自動火災報知機を設置している。また、施設内各所に消火器を設置している。"]
["室名",{"$nulls":6},"備品の品名及び数量"]
[]
["・相談室",{"$nulls":6},"机　１、いす　４、パーテーション　２"]
["・作業・訓練室１",{"$nulls":6},"机　５、いす　15、システムキッチン一式"]
["・作業・訓練室２",{"$nulls":6},"訓練用作業テーブル　１、訓練用マット　５\n訓練用鏡　１、移動式平行棒　１"]
["・作業・訓練室３",{"$nulls":6},"机　５、いす　15、テレビ　１、ビデオ　１"]
["・食堂",{"$nulls":6},"食堂用テーブル　８、いす　20、配膳棚　１\n冷蔵庫　１、食器棚　１"]
["・浴室",{"$nulls":6},"特別浴用浴槽、一般用浴槽、脱衣籠"]
["・居室",{"$nulls":6},"ベッド　１、チェスト　１"]
["・非常災害設備",{"$nulls":6},"スプリンクラー、消火器、誘導灯、自動火災報知機"]
[]
[]
["備考１　申請するサービス種類に関して、基準省令で定められた設備基準上適合すべき項目のうち、\n　　　「居室面積等一覧表」に記載した設備について記載してください。"]
["　　２　必要に応じて写真等を添付し、その旨を合わせて記載してください。"]
["　　３　「適合の可否」欄には、何も記載しないでください。"]

{"sheet":"参考１０苦情処理の概要","index":14,"n_rows":33,"n_cols":25,"rows_kept":33,"cut":false,"hidden":false,"merged":[[31,0,31,24],[18,0,19,24],[20,1,25,24],[27,1,29,24],[2,12,2,23],[1,0,1,24],[4,0,5,24],[6,0,7,24],[32,0,32,24],[2,6,2,11],[3,6,3,11],[3,12,3,23],[26,0,26,24],[8,1,17,24],[30,0,30,24]],"flags":["formulas_cached_only"]}
["（参考様式１０）"]
["利用者又はその家族からの苦情を処理するために講ずる措置の概要"]
[{"$nulls":6},"事業所・施設の名称（",{"$nulls":17},"）"]
[{"$nulls":6},"サービスの種類（",{"$nulls":17},"）"]
["措　置　の　概　要"]
[]
["１　利用者等からの相談又は苦情等に対応する常設の窓口(連絡先)、担当者の設置"]
{"$rows_empty":11}
["２　円滑かつ迅速に苦情処理を行うための処理体制・手順"]
{"$rows_empty":7}
["３　その他参考事項"]
[]
[]
[]
["備考１　申請するサービス種類に関して、基準省令で定められた設備基準上適合すべき項目のうち、\n　　　「居室面積等一覧表」に記載した設備について記載してください。"]
["　　２　必要に応じて写真等を添付し、その旨を合わせて記載してください。"]
["　　３　「適合の可否」欄には、何も記載しないでください。"]

{"sheet":"参考１０苦情処理の概要【記入例】","index":15,"n_rows":33,"n_cols":25,"rows_kept":33,"cut":false,"hidden":false,"merged":[[32,0,32,24],[2,6,2,11],[3,6,3,11],[3,12,3,23],[23,2,23,24],[24,2,24,24],[25,2,25,24],[28,2,28,24],[29,2,29,24],[26,0,26,24],[27,2,27,24],[30,0,30,24],[31,0,31,24],[18,0,19,24],[20,2,20,24],[21,2,21,24],[22,2,22,24],[11,2,11,5],[12,2,12,5],[13,2,14,24],[15,2,15,5],[15,7,15,24],[16,7,16,24],[2,12,2,23],[1,0,1,24],[4,0,5,24],[6,0,7,24],[8,2,9,24],[10,2,10,5]],"flags":["formulas_cached_only"]}
["（参考様式１０）"]
["利用者又はその家族からの苦情を処理するために講ずる措置の概要"]
[{"$nulls":6},"事業所・施設の名称（",{"$nulls":5},"大阪府庁障害福祉サービスセンター",{"$nulls":11},"）"]
[{"$nulls":6},"サービスの種類（",{"$nulls":5},"生活介護、就労継続支援（Ｂ型）",{"$nulls":11},"）"]
["措　置　の　概　要"]
[]
["１　利用者等からの相談又は苦情等に対応する常設の窓口(連絡先)、担当者の設置"]
[]
[null,"◎","相談、苦情に関する常設窓口として、相談担当者を設けている。また、担当者が不在の場合においても、事業所の誰もが対応できるように相談苦情管理対応シートを作成し、担当者に確実に引き継ぐ体制を敷いている。"]
[]
[null,null,"常設窓口",{"$nulls":4},"（電話）０６－６９４１－０３５１"]
[{"$nulls":7},"（ＦＡＸ）０６－６９４１－○○○○"]
[null,null,"担当者",{"$nulls":4},"府庁花子、大阪太郎"]
[null,"◎","利用者からの苦情に適切に対処するため、当事業所関係者及び利用者以外の中立・公正な「第三者委員」を設置し、双方の間に入って助言を行い、話し合いに立ち会うなど、積極的な役割を果たしてもらっている。"]
[]
[null,null,"第三者委員",{"$nulls":4},"○○　○○（弁護士）"]
[{"$nulls":7},"○○　○○（○○法人○○○　監事）"]
[]
["２　円滑かつ迅速に苦情処理を行うための処理体制・手順"]
[]
[null,"◎","苦情又は相談があった場合、利用者の状況を詳細に把握するよう、必要に応じ、状況の聞き取りのための訪問を実施し、事情の確認を行う。"]
[null,"◎","相談担当者は、把握した状況を管理者とともに検討を行い、対応を決定する。"]
[null,"◎","対応内容に基づき、必要に応じて関係者への連絡調整を行うとともに、利用者へは必ず対応方法を含めた結果報告を行う。（時間を要する内容もその旨を翌日までに連絡する。）"]
[]
[]
[]
["３　その他参考事項"]
[null,"◎","当事業所において、処理し得ない内容についても、適切な対応方法を利用者の立場にたって検討し、対処する。"]
[]
[]
["備考１　申請するサービス種類に関して、基準省令で定められた設備基準上適合すべき項目のうち、\n　　　「居室面積等一覧表」に記載した設備について記載してください。"]
["　　２　必要に応じて写真等を添付し、その旨を合わせて記載してください。"]
["　　３　「適合の可否」欄には、何も記載しないでください。"]

{"sheet":"参考１１協力医療機関等","index":16,"n_rows":14,"n_cols":30,"rows_kept":14,"cut":false,"hidden":false,"merged":[[3,7,3,17],[5,0,5,9],[6,0,6,9],[12,0,12,9],[12,10,12,16],[2,7,2,17],[7,0,11,9],[7,12,7,21],[11,12,11,21],[8,12,8,21],[9,12,9,21],[10,12,10,21],[2,19,3,27],[7,24,7,33],[8,24,8,33],[12,17,12,19],[12,20,12,21],[12,22,12,23],[12,24,12,26],[12,27,12,28],[12,29,12,33],[8,22,8,23],[9,22,9,23],[10,22,10,23],[11,22,11,23],[9,24,9,33],[10,24,10,33],[11,24,11,33],[13,0,30,9],[13,10,30,33],[5,10,5,33],[6,10,6,33],[7,10,7,11],[8,10,8,11],[9,10,9,11],[10,10,10,11],[11,10,11,11],[7,22,7,23]],"flags":["formulas_cached_only"]}
["（参考様式１１）"]
[]
[{"$nulls":7},"協力医療機関",{"$nulls":11},"との契約の内容"]
[{"$nulls":7},"協力歯科医療機関"]
[]
["協力（歯科）医療\n機関の名称"]
["協力（歯科）医療\n機関の所在地"]
["協力（歯科）医療\n機関の診療科",{"$nulls":9},"1)",{"$nulls":11},"2)"]
[{"$nulls":10},"3)",{"$nulls":11},"4)"]
[{"$nulls":10},"5)",{"$nulls":11},"6)"]
[{"$nulls":10},"7)",{"$nulls":11},"8)"]
[{"$nulls":10},"9)",{"$nulls":11},"10)"]
["協力（歯科）医療機関と\n事業所・施設との距離、\n移動手段及び所要時間",{"$nulls":16},"Ｋｍ（",null,null,"徒歩",null,null,null,"分、車",{"$nulls":4},"分）"]
["協力（歯科）医療機関との契約内容"]

{"sheet":"参考１１協力医療機関等【記入例】","index":17,"n_rows":14,"n_cols":30,"rows_kept":14,"cut":false,"hidden":false,"merged":[[13,0,30,9],[13,10,30,33],[5,10,5,33],[6,10,6,33],[7,10,7,11],[8,10,8,11],[9,10,9,11],[10,10,10,11],[11,10,11,11],[7,22,7,23],[11,24,11,33],[12,17,12,19],[12,20,12,21],[12,22,12,23],[12,24,12,26],[12,27,12,28],[12,29,12,33],[11,22,11,23],[9,12,9,21],[10,12,10,21],[2,19,3,27],[7,24,7,33],[8,24,8,33],[9,24,9,33],[10,24,10,33],[8,22,8,23],[9,22,9,23],[10,22,10,23],[3,7,3,17],[5,0,5,9],[6,0,6,9],[12,0,12,9],[12,10,12,16],[2,7,2,17],[7,0,11,9],[7,12,7,21],[11,12,11,21],[8,12,8,21]],"flags":["formulas_cached_only"]}
["（参考様式１１）"]
[]
[{"$nulls":7},"協力医療機関",{"$nulls":11},"との契約の内容"]
[{"$nulls":7},"協力歯科医療機関"]
[]
["協力（歯科）医療\n機関の名称",{"$nulls":9},"○○○○病院"]
["協力（歯科）医療\n機関の所在地",{"$nulls":9},"大阪市中央区○○町○丁目○番○号"]
["協力（歯科）医療\n機関の診療科",{"$nulls":9},"1)",null,"内科",{"$nulls":9},"2)",null,"精神科"]
[{"$nulls":10},"3)",null,"外科",{"$nulls":9},"4)",null,"眼科"]
[{"$nulls":10},"5)",null,"皮膚科",{"$nulls":9},"6)",null,"脳神経外科"]
[{"$nulls":10},"7)",null,"心臓内科",{"$nulls":9},"8)",null,"リハビリテーション科"]
[{"$nulls":10},"9)",null,"アレルギー科",{"$nulls":9},"10)",null,"その他"]
["協力（歯科）医療機関と\n事業所・施設との距離、\n移動手段及び所要時間",{"$nulls":9},"１．０",{"$nulls":6},"Ｋｍ（",null,null,"徒歩",null,"２０",null,"分、車",null,null,"５",null,"分）"]
["協力（歯科）医療機関との契約内容",{"$nulls":9},"協力病院と以下のような契約を締結し、緊急時等に対する体制を整えている。\n\n１　入所者の緊急な医学的治療を要する際には、迅速に入院、往診等の処置を行う。\n２　日祝祭日並びに夜間についても、入所者の緊急な医学的治療を要する場合は、直ちに医学的処遇を行うため万全の体制を確保する。\n３　相互に疑義を生じたときは、双方誠実に協議し、善処するものとする。　　等\n\n\n詳細は、別添契約書のとおり。"]

{"sheet":"参考１４非該当誓約書","index":18,"n_rows":35,"n_cols":22,"rows_kept":35,"cut":false,"hidden":false,"merged":[[2,0,2,33],[4,12,6,14],[4,15,4,19],[6,15,6,19],[6,21,6,33],[26,2,26,32],[28,2,28,32],[30,2,30,32],[5,15,5,19],[8,1,8,32],[4,21,4,33],[5,21,5,33],[32,2,32,32],[34,2,34,32],[9,1,9,32],[12,2,12,32],[14,2,14,32],[16,2,16,32],[18,2,18,32],[20,2,20,32],[22,2,22,32],[24,2,24,32]],"flags":["formulas_cached_only"]}
["（参考様式１４）"]
[]
["障害者自立支援法第36条第3項各号の規定に該当しない旨の誓約書"]
[]
[{"$nulls":12},"申請者",null,null,"主たる事務所\nの所在地",{"$nulls":4},"：","東大阪市中小阪４－７－４７　"]
[{"$nulls":15},"名　　称",{"$nulls":4},"：","ＮＰＯ法人三和福祉会"]
[{"$nulls":15},"代表者の職・氏名",{"$nulls":4},"：","理事長　田中　米男"]
[]
[null,"　当法人及び別紙記載の役員等は、下記に掲げる障害者自立支援法第36条第3項各号の規定のいずれにも該当しないことを誓約します。"]
[null,"記"]
[null,"【障害者自立支援法第36条第3項各号の規定】（一部要約）"]
[]
[null,1,"　申請者が法人でないとき。"]
[]
[null,2,"　当該申請に係るサービス事業所の従業者の知識及び技能並びに人員が、第43条第1項の厚生労働省令で定める基準を満たしていないとき。"]
[]
[null,3,"　申請者が、第43条第2項の厚生労働省令で定める指定障害福祉サービスの事業の設備及び運営に関する基準に従って適正な障害福祉サービス事業の運営をすることができないと認められるとき。"]
[]
[null,4,"　申請者が、禁錮以上の刑に処せられ、その執行を終わり、又は執行を受けることがなくなるまでの者であるとき。"]
[]
[null,5,"　申請者が、この法律その他国民の保健医療若しくは福祉に関する法律で政令で定めるもの（※）の規定により罰金の刑に処せられ、その執行を終わり、又は執行を受けることがなくなるまでの者であるとき。"]
[]
[null,null,"（※）児童福祉法、身体障害者福祉法、精神保健及び精神障害者福祉に関する法律、社会\n　　福祉法、老人福祉法、社会福祉士及び介護福祉士法、介護保険法、精神保健福祉士法"]
[]
[null,6,"　申請者が、第50条第1項の規定により指定を取り消され、その取消しの日から起算して5年を経過しない者（当該指定を取り消された者が法人である場合においては、当該取消しの処分に係る行政手続法第15条の規定による通知があった日前60日以内に当該法人の役員又はそのサービス事業所を管理する者（以下「役員等」という。）であった者で当該取消しの日から起算して５年を経過しないものを含み、当該指定を取り消された者が法人でない場合においては、当該通知があった日前60日以内に当該者の管理者であった者で当該取消しの日から起算して"]
[]
[null,7,"　申請者が、第50条第1項の規定による指定の取消しの処分に係る行政手続法第15条の規定による通知があった日から当該処分をする日又は処分をしないことを決定する日までの間に第46条第1項の規定による事業の廃止の届出をした者（当該事業の廃止について相当の理由がある者を除く。）で、当該届出の日から起算して5年を経過しないものであるとき。"]
[]
[null,8,"　前号に規定する期間内に第46条第1項の規定による事業の廃止の届出があった場合において、申請者が、同号の通知の日前60日以内に当該届出に係る法人（当該事業の廃止について相当の理由がある法人を除く。）の役員等又は当該届出に係る法人でない者（当該事業の廃止について相当の理由がある者を除く。）の管理者であった者で、当該届出の日から起算して5年を経過しないものであるとき。"]
[]
[null,9,"　申請者が、指定の申請前5年以内に障害福祉サービスに関し不正又は著しく不当な行為をした者であるとき。"]
[]
[null,10,"　申請者が、法人で、その役員等のうちに第4号から前号までのいずれかに該当する者のあるものであるとき。"]
[]
[null,11,"　申請者が、法人でない者で、その管理者が第4号から第9号までのいずれかに該当する者であるとき。"]

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["（参考様式１４　別紙）"]
[null,null,"役　　　員　　　等　　　名　　　簿"]
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[null,"ﾌﾘｶﾞﾅ",null,"生年月日",{"$nulls":5},"住　　　　　　　　　　　所"]
[null,"氏　　名",null,"役職名・呼称",{"$nulls":6},"電話番号",{"$nulls":7},"ＦＡＸ番号"]
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[null,"田中　米男","理事長",{"$nulls":6},"高井田本通２丁目７番２号３０２号室"]
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["３","アズマシゲユキ","昭",13,"年",9,"月",15,"日","（郵便番号",null,"577","－","0809",null,"）"]
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[{"$nulls":12},"府","県",null,null,null,"区"]
[null,"東　成行","理事",{"$nulls":6},"永和３丁目１１番１３号"]
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["４","イシダ　ミキコ","昭",24,"年",11,"月",1,"日","（郵便番号",null,"577","－","0805",null,"）"]
[{"$nulls":9},"大阪",null,null,"都","道","東大阪",null,null,"郡","市"]
[{"$nulls":12},"府","県",null,null,null,"区"]
[null,"石田　幹子","監事",{"$nulls":6},"宝持４丁目１番６号"]
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["５",null,"　",null,"年",null,"月",null,"日","（郵便番号",null,null,"－",null,null,"）"]
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[]
[{"$nulls":11},"－",null,null,"－",{"$nulls":4},"－",null,null,"－"]
["６",null,"　",null,"年",null,"月",null,"日","（郵便番号",null,null,"－",null,null,"）"]
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[]
[{"$nulls":11},"－",null,null,"－",{"$nulls":4},"－",null,null,"－"]
["７",null,"　",null,"年",null,"月",null,"日","（郵便番号",null,null,"－",null,null,"）"]
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[]
[{"$nulls":11},"－",null,null,"－",{"$nulls":4},"－",null,null,"－"]
["８",null,"　",null,"年",null,"月",null,"日","（郵便番号",null,null,"－",null,null,"）"]
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[]
[{"$nulls":11},"－",null,null,"－",{"$nulls":4},"－",null,null,"－"]
["９",null,"　",null,"年",null,"月",null,"日","（郵便番号",null,null,"－",null,null,"）"]
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[]
[{"$nulls":11},"－",null,null,"－",{"$nulls":4},"－",null,null,"－"]
["１０",null,"　",null,"年",null,"月",null,"日","（郵便番号",null,null,"－",null,null,"）"]
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[]
[{"$nulls":11},"－",null,null,"－",{"$nulls":4},"－",null,null,"－"]
["注：\n\n\n","当該法人の役員（業務を執行する役員、取締役、執行役又はこれらに準ずる者をいい、相談役、顧問その他いかなる名称を有する者であるかを問わず、法人に対し業務を執行する社員、取締役、執行役又はこれらに準ずる者と同等の支配力を有する者と認められるものを含む。）及び事業所を管理する者について記入すること。"]

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["（参考様式１５）"]
[null,null,"指定障害福祉サービスの主たる対象者を特定する理由"]
[{"$nulls":6},"事業所・施設の名称（",{"$nulls":17},"）"]
[{"$nulls":6},"サービスの種類（",{"$nulls":17},"）"]
["１　指定障害福祉サービスを提供する主たる対象者（該当するものに○を記入すること。）"]
[]
[null,"身体障害者",{"$nulls":11},"知的障害者",null,null,"障害児",null,null,"精神障害者"]
[null,"肢体不自由",null,null,"視覚",null,null,"言語・聴覚",null,null,"内部"]
[]
[]
["２　指定障害福祉サービスを提供する主たる対象者を１のとおりとする理由"]
[]
[]
[]
[]
[]
[]
["３　今後、指定障害福祉サービスを提供する主たる対象者を拡充する予定の有無"]
[null,"（１）拡充の予定の有無"]
[null,null,null,"あり",null,"・","なし"]
[]
[null,"（２）拡充予定の内容及び予定時期"]
[null,null,null,"(内容)"]
[]
[]
[]
[null,null,null,"(時期)",null,"平成",null,null,"年",null,"月"]
[]
[null,"（３）拡充のための方策"]