To: NIPPON KAIJI KYOKAI Date: Sites included in the scope of certification (Please fill out about all sites.) No. Details of Each Site (☑：check the appropriate box.) Name of Site: Address Scope of Certification Type of shift: 2-shift 3-shift Number of people in the Shift Work : □ □ Others ( ) site: □ 1 Not applied □ *Number of shift worker: ( ) Persons ( ) Persons Applied □ Approx. number of Kind of shift work: (Please fill out cooperative company ( ) the right column worker with details) Kind of work of each shift : Same Different among mentioned above: □ □ ( ) Persons Level of control of each shift: Same Different □ □ Name of Site: Address Scope of Certification Type of shift: 2-shift 3-shift Number of people in the Shift Work : □ □ Others ( ) □ site: Not applied 2 □ *Number of shift worker: ( ) Persons ( ) Persons Applied □ Approx. number of Kind of shift work: (Please fill out cooperative company the right column ( ) worker with details) Kind of work of each shift : Same Different among mentioned above: □ □ ( ) Persons Level of control of each shift: Same Different □ □ Name of Site: Address Scope of Certification Type of shift: 2-shift 3-shift Number of people in the Shift Work : □ □ Others ( ) site: □ 3 Not applied □ *Number of shift worker: ( ) Persons ( ) Persons Applied □ Approx. number of Kind of shift work: (Please fill out cooperative company ( ) the right column worker with details) Kind of work of each shift : Same Different among mentioned above: □ □ ( ) Persons Level of control of each shift: Same Different □ □ Name of Site: Address Scope of Certification Type of shift: 2-shift 3-shift Number of people in the Shift Work : □ □ Others ( ) □ site: Not applied 4 □ *Number of shift worker: ( ) Persons ( ) Persons Applied □ Approx. number of Kind of shift work: (Please fill out cooperative company ( ) the right column worker with details) Kind of work of each shift : Same Different among mentioned above: □ □ ( ) Persons Level of control of each shift: Same Different □ □ *Example: In case of 2-shift with 15 persons each, please fill out 30 persons in this column.
To: NIPPON KAIJI KYOKAI Date: Sites included in the scope of certification (Please fill out about all sites.) No. Details of Each Site (☑：check the appropriate box.) 1 Name of Site: Address Scope of Certification Number of people in the site: ( ) Persons Shift Work : □ Not applied □ Applied (Please fill out the right column with details) Type of shift: □ 2-shift □ 3-shift □ Others ( ) *Number of shift worker: ( ) Persons Approx. number of cooperative company worker among mentioned above: ( ) Persons Kind of shift work: ( ) Kind of work of each shift : □ Same □ Different Level of control of each shift: □ Same □ Different 2 Name of Site: Address Scope of Certification Number of people in the site: ( ) Persons Shift Work : □ Not applied □ Applied (Please fill out the right column with details) Type of shift: □ 2-shift □ 3-shift □ Others ( ) *Number of shift worker: ( ) Persons Approx. number of cooperative company worker among mentioned above: ( ) Persons Kind of shift work: ( ) Kind of work of each shift : □ Same □ Different Level of control of each shift: □ Same □ Different 3 Name of Site: Address Scope of Certification Number of people in the site: ( ) Persons Shift Work : □ Not applied □ Applied (Please fill out the right column with details) Type of shift: □ 2-shift □ 3-shift □ Others ( ) *Number of shift worker: ( ) Persons Approx. number of cooperative company worker among mentioned above: ( ) Persons Kind of shift work: ( ) Kind of work of each shift : □ Same □ Different Level of control of each shift: □ Same □ Different 4 Name of Site: Address Scope of Certification Number of people in the site: ( ) Persons Shift Work : □ Not applied □ Applied (Please fill out the right column with details) Type of shift: □ 2-shift □ 3-shift □ Others ( ) *Number of shift worker: ( ) Persons Approx. number of cooperative company worker among mentioned above: ( ) Persons Kind of shift work: ( ) Kind of work of each shift : □ Same □ Different Level of control of each shift: □ Same □ Different *Example: In case of 2-shift with 15 persons each, please fill out 30 persons in this column.
FORM_QA-50-60E.docx