{"text_format":"1","workbook":"xlsx","n_sheets":6,"sheets":["はじめに、ご確認ください","【作成してください】シート「事前提出資料」","【作成してください】シート「栄養摂取状況等」","【入力しないでください】シート「事前提出資料」集計","【入力しないでください】シート「給食・栄養摂取状況」集計","【入力しないでください】プルダウン・選択肢"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":4,"comments":1,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

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[]
[]
[]
["事前提出資料　栄養・衛生管理関係書類"]
["〔 老人福祉施設等・短期入所 〕"]
[]
["　　　　　　・・・ 以下の点に留意して、"]
["シート「事前提出資料」と「栄養摂取状況等」の作成をお願いします・・・"]
[]
["＊","施設と併設の「短期入所生活介護」の栄養・衛生管理を一括して報告できる場合は、"]
[null,"事前提出資料はまとめて作成しても差し支えありません。"]
[null,"その場合は、シート「事前提出資料」のはじめの問いで、「はい」を選択してください。"]
[null,"一括できない項目・内容がある場合は、それぞれに作成し、提出してください。"]
[]
[" ◆　シート「事前提出資料」の記入方法について"]
[null,"各項目について、セルの色により、以下の形式で記入してください。"]
[]
[null,null,"プルダウン",null,"　・・・　リストから選択してください。"]
[]
[null,null,null,null,"　・・・　直接入力してください。"]
[]
[null,null,null,null,"　・・・　該当する項目の □ に✓を入れてください。"]
[]
[]
[" ◆　シート「栄養摂取状況等」の記入方法について"]
[]
[null,null,"プルダウン",null,"　・・・　リストから選択してください。"]
[]
[null,null,null,null,"　・・・　コメント欄の説明を参考に、直接入力してください。"]
[]
[" （お願い） この資料は、EXCELデータのままでの提出にご協力お願いいたします。"]
[]
["◆　本資料のほか、下記①～③の書類(写し)もあわせて提出してください。"]
[]
["①","現在使用している施設基準（療養食を含めた各食種の給与栄養目標量、給与食品目標量）"]
["②","基本食種の、当年度5月の連続した1週間分の献立（1人分の食材名・分量が記載されたもの）"]
["③","調理室の図面　（原材料の搬入から、下処理、調理、盛付・配膳作業、搬出口、下膳、食器洗浄、"]
[null,"食器保管作業に至るまでの動線がわかるように示してください）"]

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[]
[]
[]
["事前提出資料　栄養・衛生管理関係書類"]
["（老人福祉施設等・短期入所）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"作成日",null,"令和",null,null,null,"年",null,null,"月",null,null,"日"]
[]
["＊","施設と、併設の短期入所生活介護の栄養・衛生管理について、まとめて作成しますか。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," ※「いいえ」の場合は、それぞれに作成し、提出してください。"]
[null,null,null,null,"ふりがな",null,null,null,null,null,null,null,null,null,"ふりがな"]
[null,null,null,null,"（法人名）",null,null,null,null,null,null,null,null,null,"（施設名）"]
[]
[null,null,null,"施設名 "]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"短期入所生活介護事業所名 "]
[null,null,null,null,null,null,null,null,null,"ふりがな"]
[null,null,null,null,"(職名）",null,null,null,null,"(氏　名）"]
[null,"記入者名 ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"連絡先TEL "]
[]
[]
["Ⅰ"," 給食運営の状況"]
[null,1,"運営方法"]
[null,null,"「業務委託（一部委託も含む）」を選択した場合、以下①～⑤についてご記入ください。"]
[null,null,"①","委託業者",null,null,"業者名"]
[]
[null,null,null,null,null,null,"所在地"]
[]
[null,null,"②","委託業務内容",null,null,null,null,null,"献立作成",null,null,"食材調達",null,null,"調理",null,null,"盛り付け",null,null,"配膳",null,null,"下膳",null,null,"食器洗浄\n消毒"]
[null,null,null,null,"(該当項目に〇を記入）"]
[null,null,null,null,null,null,null,null,null,"清掃",null,null,"その他",null,null,"⇒ 「その他」の内容"]
[]
[]
[null,null,null,null,null,null,null,null,null,"（所属）",null,null,null,null,null,null,"(職種）",null,null,null,null,null,null,"（氏名）"]
[null,null,"③","委託側栄養士"]
[null,null,null,"※専門的な立場から必要な指導を行う栄養士"]
[]
[null,null,"④","委託業者による\n施設への巡回指導",null,null,null,null,null,null,null,"⇒「有」の場合、実施回数は",null,null,null,null,null,null,null,null,null,"に",null,null,"回"]
[null,null,null,null,null,null,null,null,null,"（所属）",null,null,null,null,null,null,"(職種）",null,null,null,null,null,null,"（氏名）"]
[null,null,null,"巡回指導担当者"]
[]
[null,null,"⑤","委託契約年月日",null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[null,2,"給食業務従事者数",null,null,null,null,null,null,"所属",null,null,"管理栄養士",null,null,null,"栄養士",null,null,null,"調理師",null,null,null,"調理従事者"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（常勤再掲）",null,null,null,"（常勤再掲）",null,null,null,"（常勤再掲）",null,null,null,"（常勤再掲）"]
[null,null,null,null,null,null,null,null,null,"施設",null,null,null,"人",null,"人",null,"人",null,"人",null,"人",null,"人",null,"人",null,"人"]
[null,null,null,null,null,null,null,null,null,"委託",null,null,null,"人",null,"人",null,"人",null,"人",null,"人",null,"人",null,"人",null,"人"]
[]
[null,3,"調理を行う場所"]
[null,null,"①","調理室（厨房）",null,null,null,null,null,null,null,"⇒「有」の場合、調理行為は　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"　⇒「その他」の内容"]
[]
[null,null,"②","居室エリアのキッチン",null,null,null,null,null,null,null,"⇒「有」の場合、調理行為は　"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"　⇒「その他」の内容"]
[]
[null,null,"③","その他の調理場所",null,null,null,null,null,null,null,"　⇒「有」の場合、場所等は"]
[]
[]
[null,4,"調理方法"]
[]
[null,null,null,null,null,null,null,null,null,"※施設外調理とは、当該施設以外の調理加工施設（セントラルキッチン、他施設の調理室等）で調理された場合をいいます。"]
[]
[null,"＊","「施設内調理」の状況について、以下①についてご記入ください。"]
[null,null,"①","調理方式",null,null,null,"当日調理",null,null,"事前調理"]
[null,null,"(該当項目に〇を記入）",null,null,null,null,null,null,null,null,null,null,"⇒",null,null,"日前に調理"]
[null,null,"⇒","事前調理の\n調理方式 "]
[null,null,null,null,null,null,null,"クックチル",null,null,"クックフリーズ",null,null,"真空調理",null,null,"クックサーブ",null,null,"その他",null,null,"⇒「その他」の内容"]
[null,null,"(該当項目に〇を記入）"]
[]
[null,"＊","「施設外調理」の状況について、以下①～②についてご記入ください。"]
[null,null,"①","調理方式",null,null,null,"当日調理",null,null,"事前調理"]
[null,null,"(該当項目に〇を記入）",null,null,null,null,null,null,null,null,null,null,"⇒",null,null,"日前に調理"]
[null,null,"⇒","事前調理の\n調理方式 "]
[null,null,null,null,null,null,null,"クックチル",null,null,"クックフリーズ",null,null,"真空調理",null,null,"クックサーブ",null,null,"その他",null,null,"⇒「その他」の内容"]
[null,null,"(該当項目に〇を記入）"]
[]
[null,null,"②","搬入元",null,null,null,"施設・事業者名"]
[]
[null,null,null,null,null,null,"所在地　"]
[]
[null,"＊","「施設外調理」で「当日調理」を選択した場合は、以下①②についてご記入ください。"]
[null,null,"①","運搬にかかる時間",null,null,null,null,null,null,null,null,null,"分　～",null,null,null,"分"]
[]
[null,null,"②","運搬方法",null,null,null,"保温・\n保冷配膳車",null,null,"保温\nボックス",null,null,"保冷\nボックス",null,null,"ホテルパン\n・食缶等",null,null,"その他",null,null,"⇒「その他」の内容"]
[null,null,"(該当項目に〇を記入）"]
[]
[null,5,"他施設・事業所への配食・食事提供",null,null,null,null,null,null,null,null,null,null,null,"※他施設・事業所への配食・食事提供とは、当該施設の調理室で調理した食事を、他施設・他事業所（通所サービスなど）の利用者の食事として配食する場合をいいます。"]
[]
[null,null,"「有」を選択した場合は、以下①～②についてご記入ください。"]
[null,null,"①","配食先",null,null,null,"施設・事業所名"]
[null,null,null,null,null,null,null,"（すべて記入）"]
[]
[null,null,"②","配食先の場所",null,null,null,null,null,null,null,null,null,null,null,null,"⇒「その他」の内容"]
[]
[null,null,"③","運搬にかかる時間",null,null,null,null,null,null,null,null,null,"分　～",null,null,null,"分"]
[]
[null,null,"④","運搬方法",null,null,null,"保温・\n保冷配膳車",null,null,"保温\nボックス",null,null,"保冷\nボックス",null,null,"ホテルパン\n・食缶等",null,null,"その他",null,null,"⇒「その他」の内容"]
[null,null,"(該当項目に〇を記入）"]
[]
[null,6,"平日・１日の平均食数"]
[null,null,null,null,null,null,null,null,"朝食",null,null,"昼食",null,null,"夕食",null,null,"計",null,null,"間食",null,null,"備考"]
[null,null,"入　　所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(I104:Q104)","v":0}]
[null,null,"短期入所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(I105:Q105)","v":0}]
[null,null,"計",null,null,null,null,null,{"$f":"SUM(I104:K105)","v":0},null,null,{"$f":"SUM(L104:N105)","v":0},null,null,{"$f":"SUM(O104:Q105)","v":0},null,null,{"$f":"SUM(R104:T105)","v":0},null,null,{"$f":"SUM(U104:W105)","v":0}]
[null,null,"通　　所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(I107:Q107)","v":0}]
[null,null,"職　　員",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(I108:Q108)","v":0}]
[null,null,"その他 : ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(I109:Q109)","v":0}]
[null,null,"合　　計",null,null,null,null,null,{"$f":"SUM(I106:K109)","v":0},null,null,{"$f":"SUM(L106:N109)","v":0},null,null,{"$f":"SUM(O106:Q109)","v":0},null,null,{"$f":"SUM(R106:T109)","v":0},null,null,{"$f":"SUM(U106:W109)","v":0}]
[]
[null,7,"食堂の状況"]
[null,null,"階",null,null,null,"食堂の場所",null,null,null,null,null,null,null,null,null,null,null,"利用可能人数"]
[null,"（記入例）",2,null,null,null,"フロア南",null,null,null,null,null,null,null,null,null,null,null,20,null,null,null,null,"人"]
[null,null,"3～５",null,null,null,"各階・２ユニット1か所ずつ",null,null,null,null,null,null,null,null,null,null,null,"各８",null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
[null,8,"給食材料費"]
[null,null,null,null,null,null,null,null,"年間の給食材料費",null,null,null,null,null,null,null,"1人1日当たりの平均給食材料費"]
[null,null,"前年度実績",null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,"円"]
[null,null,"当年度予算",null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,"円"]
[]
[null,9," 職員給食の実施状況"]
[null,null,"「提供あり」を選択した場合は、以下についてご記入ください。"]
[null,null,null,null,null,null,null,null,"朝食",null,null,"昼食",null,null,"夕食",null,null,"間食",null,null,"合計",null,null,"負担額の算出根拠"]
[null,null,"本人負担額（円）",null,null,null,null,null,null,null,"円",null,null,"円",null,null,"円",null,null,"円",{"$f":"I128+L128+O128+R128","v":0},null,"円"]
[null,null,"１日平均利用者数（人）",null,null,null,null,null,null,null,"人",null,null,"人",null,null,"人",null,null,"人",{"$f":"I129+L129+O129+R129","v":0},null,"人"]
[]
[null,10,"給食施設の届出状況"]
[null,null,"①","営業届出 〔集団給食施設〕　　　※直営で給食を運営する施設のみ"]
[]
[null,null,"②","委託業者の営業許可 〔飲食店営業〕　　　※給食運営を業務委託している施設のみ"]
[]
[null,null,"③","特定給食施設開始届　　※1回100食以上または1日250食以上の食事を供給する施設"]
[]
["Ⅱ"," 栄養管理の状況"]
[null,1,"栄養管理に関する会議　（給食委員会など、前年度実績）"]
[null,null,"「有」を選択した場合は、以下①～③についてご記入ください。"]
[]
[null,null,"①","開催状況",null,null,null,null,null,null,null," に開催　",null,null,null,null,"に",null,null,"回",null,"会議録　"]
[]
[null,null,"②","構成職種",null,null,null,null,"管理者",null,null,"事務長",null,null,"医　師",null,null,"施設栄養士",null,null,"調理師\n調理員",null,null,"看護職員",null,null,"介護職員"]
[null,null,null,"(該当項目に〇を記入）"]
[null,null,null,null,null,null,null,null,"生活相談員",null,null,"委託業者\nスタッフ",null,null,"その他",null,null,"⇒ 「その他」の内容"]
[]
[]
[null,null,"③","開催目的",null,null,null,null,"栄養管理の課題把握\n・解決のための検討",null,null,null,null,null,"関係部門との\n連携",null,null,null,"苦情処理",null,null,null,"献立内容の\n検討"]
[null,null,null,"(該当項目に〇を記入）"]
[null,null,null,null,null,null,null,null,"その他",null,null,null,"⇒ 「その他」の内容"]
[]
[]
[null,2," 個別対応の食事　（当年度5月の状況）"]
[null,null,null,null,null,null,null,null,"嚥下困難食",null,null,"経管栄養食",null,null,"治療食",null,null,"ｱﾚﾙｷﾞｰ除去・代替食",null,null,"嗜好・宗教等個別対応"]
[null,null,null,"(該当項目に〇を記入）"]
[null,null,null,null,null,null,null,null,"その他",null,null,"⇒ 「その他」の内容"]
[]
[]
[null,3," 検食の実施状況"]
[null,null,null,null,null,null,null,"食事時間",null,null,null,null,null,"検食時間",null,null,null,null,null,"1回あたり検食者数",null,null,null,null,"記録の有無"]
[null,null,null,"朝　食",null,null,null,null,null,"時",null,null,"分",null,null,"時",null,null,"分",null,null,null,null,"人"]
[null,null,null,"昼　食",null,null,null,null,null,"時",null,null,"分",null,null,"時",null,null,"分",null,null,null,null,"人"]
[null,null,null,"夕　食",null,null,null,null,null,"時",null,null,"分",null,null,"時",null,null,"分",null,null,null,null,"人"]
[null,null,null,"間　食",null,null,null,null,null,"時",null,null,"分",null,null,"時",null,null,"分",null,null,null,null,"人"]
[]
[null,null,"＊","検食担当者の職種",null,null,null,null,"施設長",null,null,"事務職",null,null,"施設栄養士",null,null,"看護職員",null,null,"介護職員",null,null,"生活相談員"]
[null,null,null,"(該当項目に〇を記入）"]
[null,null,null,null,null,null,null,null,"その他",null,null,"⇒「その他」の内容"]
[]
[]
[null,4," 行事食、外食、外注の実施状況"]
[]
[null,null,"＊","行事食",null,null,null,"実施回数",null,null,null,null,"に",null,null,"回",null,"本人負担 "]
[]
[null,null,"＊","外食・外注",null,null,null,"実施回数",null,null,null,null,"に",null,null,"回",null,"本人負担 "]
[]
[null,5," 嗜好調査・残食（喫食量）調査"]
[]
[null,null,"＊","嗜好調査",null,null,null,"実施回数",null,null,null,null,"に",null,null,"回"]
[]
[null,null,null,null,null,null,null,"調査方法 ",null,null,null,null,null,null,"⇒「その他」の内容"]
[]
[null,null,"＊","残食調査",null,null,null,"実施状況"]
[]
[null,null,null,null,null,null,null,"調査方法 ",null,null,null,null,null,null,null,null,"⇒「その他」の内容"]
[]
[null,6,"非常時の対応（食事提供）"]
[null,null,"①","マニュアルの整備"]
[null,null,"＊","食中毒・感染症対策マニュアル",null,null,null,null,null,null,null,null,null,null,null,"（最新の作成又は改訂日）"]
[null,null,null,null,null,null,null,null,null,null,null,"「有」の場合⇒",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[null,null,"＊","災害時対策マニュアル",null,null,null,null,null,null,null,null,null,null,null,"（最新の作成又は改訂日）"]
[null,null,null,null,null,null,null,null,null,null,null,"「有」の場合⇒",null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[null,null,"②","食料、飲料水等の備蓄状況",null,null,null,null,null,null,null,null,null,"「有」の場合⇒",null,null,null,"食  料",null,null,null,null,"人分 × ",null,null,null,null,"日分"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"飲料水",null,null,null,null,"人分 × ",null,null,null,null,"日分"]
[]
[null,null,"③","備蓄を活用した献立",null,null,null,null,null,null,null,null,null,"「有」の場合⇒",null,null,null,"食　種",null,null,null,null,"種類 × ",null,null,null,null,"日分の献立"]
[]
[null,null,"④","食料、飲料水の保管場所"]
[]
[null,null,"＊","食　料",null,null,null,null,null,"⇒保管場所"]
[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,"＊","飲料水",null,null,null,null,null,"⇒保管場所"]
[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,"⑤","他施設等との連携",null,null,null,null,null,null,null,null,null,"「有」の場合⇒"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"「その他」の内容　⇒"]
[]
[null,7,"栄養摂取状況等　（5月分及び直近月）",null,null,null,null,null,null,null,null,null,null,"⇒","シート「栄養摂取状況等」を作成してください。"]
[]
["Ⅲ"," 衛生管理の状況"]
[null,1,"給食業務関係"]
[null,null,"①","原材料等の検収記録",null,null,null,null,null,null,null,null,null,null,"※クックチル食品等調理済食品も含みます。"]
[null,null,"「有」を選択した場合は、以下＊についてご記入ください。"]
[null,null,"＊","記録内容",null,null,null,null,null,"納品時刻",null,null,"期限表示",null,null,"数量",null,null,"鮮度",null,null,"包装",null,null,"品温",null,null,"異物"]
[null,null,null,null,"(該当項目に〇を記入）"]
[]
[null,null,"②","調理後から提供までの\n温度管理の方法",null,null,null,null,null,"保温・保冷\n配膳車",null,null,"保温庫",null,null,"保温ボックス",null,null,"保温トレイ",null,null,"保温食器",null,null,"保冷庫"]
[null,null,null,"(該当項目に〇を記入）"]
[null,null,null,null,null,null,null,null,null,"その他",null,null,"⇒ 「その他」の内容"]
[]
[]
[null,null,"③","保存食の実施状況",null,null,null,null,null,null,"保存食を保管する冷凍庫の温度記録"]
[]
[null,null,null,null,null,null,null,null,"保存方法",null,null,null,null,null,null,"保存している食事"]
[null,null,null,null,null,null,null,null,"(保存日数)",null,null,null,"(保存温度)"]
[null,null,null,"調理済食品",null,null,null,null,null,null,"日間",null,null,null,"度"]
[null,null,null,"原材料",null,null,null,null,null,null,"日間",null,null,null,"度"]
[]
[null,null,"④","検便の実施状況"]
[null,null,"＊","実施回数",null,null,null,null,"月２回は ",null,null,null,null,"月～",null,null,null,"月",null,null,"月１回は ",null,null,null,null,"月～",null,null,null,"月"]
[]
[null,null,"＊","検査項目",null,null,null,null,"赤痢菌",null,null,"サルモネラ菌",null,null,"腸チフス菌",null,null,"パラチフス菌",null,null,"ノロウィルス",null,null,"　⇒「〇」の場合、実施月"]
[]
[null,null,null,"(該当項目に〇を記入）"]
[null,null,null,null,null,null,null,null,"腸管出血性大腸菌",null,null,null,null,null,null,null,null,"その他",null,null,"⇒「その他」の内容"]
[null,null,null,null,null,null,null,null,"O-157",null,null,"O-26",null,null,"O-111"]
[]
[]
[null,null,"＊","対象者   ",null,null,null,null,"調理従事者",null,null,"施設\n栄養士",null,null,"委託\n栄養士",null,null,"介護職員"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ユニット調理",null,null,"ユニット盛付",null,null,"食事介助"]
[null,null,null,"(該当項目に〇を記入）"]
[null,null,null,null,null,null,null,null,"その他",null,null,"⇒「その他」の内容"]
[]
[]
[null,null,"⑤","調理担当者の手洗い専用設備、手洗い用石けん等の設置状況"]
[null,null,null,null,null,null,null,null,null,"手洗い\n専用設備",null,null,"手洗い用\n液体石けん",null,null,"手指用\n消毒液",null,null,"手拭き",null,null,null,null,"⇒「その他」の内容"]
[null,null,null,"調理室調理担当者用"]
[null,null,null,"ユニット調理担当者用"]
[null,null,null,"調理室担当者専用トイレ用"]
[]
[null,null,"⑥","調理室と関係エリアでのねずみ・昆虫駆除作業の実施状況",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年 ",null,null,null,"回実施"]
[null,null,"＊","直近2回分の実施状況をご記入ください。"]
[null,null,null,"実施年月日",null,null,null,null,null,null,"実施内容",null,null,null,null,null,"実施場所",null,null,null,null,null,null,"実施者",null,null,null,null,"記録の\n保管"]
[null,null,null,null,null,"年",null,"月",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,"年",null,"月",null,"日"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,"（",null,null,null,null,"）",null,null,null,null,null,null,"）"]
[]
[null,2,"施設全体の衛生管理状況"]
[null,null,"①","給食の調理や飲用に供する給水設備の状況"]
[null,null,"＊","受水槽を設置している場合、以下についてご記入ください。"]
[null,null,null,"清掃",null,null,null,null,null,"年に",null,null,null,"回実施　　前回清掃日",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,null,null,null,null,null,null,null,"清掃証明書の記録の保管"]
[]
[null,null,null,"定期検査",null,null,null,null,null,"年に",null,null,null,"回実施　　前回点検日",null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[null,null,null,null,null,"検査機関名 ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"定期検査の記録の保管　"]
[]
[null,null,"＊","水道事業により供給される水以外の井戸水等を使用している場合、以下についてご記入ください。"]
[null,null,null,"水質検査",null,null,null,null,null,"年に",null,null,null,"回実施",null,"　前回検査日",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,null,null,null,null,null,null,null,"　検査結果の記録の保管"]
[]
[null,null,"②","入浴設備の衛生管理状況",null,null,null,null,null,null,null,null,null,"循環式浴槽の設置　"]
[null,null,"＊","循環式浴槽の設置が「有」の場合、以下について記入してください。"]
[null,null,null,"階","浴槽の種類",null,null,null,"水質検査実施年月日（直近３回分）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記録の\n保管"]
[]
[null,null,"記入例",2,"一般浴槽（大浴槽）",null,null,null,"①","２０２０",null,"年","４",null,"月",12,null,"日","③","２０２２",null,"年","4",null,"月","１０",null,"日","無"]
[null,null,null,null,null,null,null,null,"③","２０２１",null,"年","4",null,"月","１０",null,"日"]
[null,null,null,null,null,null,null,null,"①",null,null,"年",null,null,"月",null,null,"日","③",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,"②",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,"①",null,null,"年",null,null,"月",null,null,"日","③",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,"②",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,"①",null,null,"年",null,null,"月",null,null,"日","③",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,"②",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,"①",null,null,"年",null,null,"月",null,null,"日","③",null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,"②",null,null,"年",null,null,"月",null,null,"日"]
[]
[null,null,"③","その他設備の衛生管理状況"]
[null,null,null,null,null,null,null,null,"手洗い用\n液体石けん",null,null,"手指用\n消毒液",null,null,"手拭き",null,null,null,null,"⇒「その他」の内容"]
[null,null,null,"共用洗面所"]
[null,null,null,"共用トイレ"]

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[]
[null,"◆","栄養摂取状況等",null,null,null,null,null,null,null,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,"施設名"]
[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,null,null,null,null,null,null,null,null,"（職名）",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記入者名"]
[]
[null,1,null,"食事提供対象者数",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入所",null,null,null,null,null,null,null,null,null,null,null,"短期入所",null,null,null,null,null,null,null,null,null,null,null,"通所"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"定員",null,null,null,null,null,"在籍",null,null,null,null,null,"定員",null,null,null,null,null,"在籍",null,null,null,null,null,"定員",null,null,null,null,null,"在籍"]
[null,null,null,"（当年度5月15日現在）",null,null,null,null,null,null,null,null,null,null,null,null,"従来型",null,null,null,null,null,null,null,null,"人",null,null,null,null,null,"人",null,null,null,null,null,"人",null,null,null,null,null,"人",null,null,null,null,null,"人",null,null,null,null,null,"人"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ユニット型",null,null,null,null,null,null,null,null,"人",null,null,null,null,null,"人",null,null,null,null,null,"人",null,null,null,null,null,"人",null,null,null,null,null,"人",null,null,null,null,null,"人"]
[]
[null,2,null,"給食数（延べ）",null,null,null,null,null,null,"（当年度5月分）",null,null,null,null,null,null,null,"総計",null,null,null,{"$f":"M13+M17","v":0},null,null,null,null,"食"]
[]
[null,null,null,"〔内訳〕",null,null,null,null,"一般食",null,null,null,{"$f":"AA13+AN13+AZ13+AA14+AN14+AA15","v":0},null,null,null,null,"食",null,"⇒",null,"普通食",null,null,null,null,null,null,null,null,"食",null,null,"全粥食",null,null,null,null,null,null,null,null,null,"食",null,null,"刻み食",null,null,null,null,null,null,null,null,"食"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ミキサー食",null,null,null,null,null,null,null,null,"食",null,null,"流動食",null,null,null,null,null,null,null,null,null,"食"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,null,null,null,"食",null,null,"⇒その他の食種名"]
[]
[null,null,null,null,null,null,null,null,"療養食",null,null,null,{"$f":"AA17+AN17+AZ17+AA18+AN18+AZ18+AA19+AN19+AH20+AZ20","v":0},null,null,null,null,"食",null,"⇒",null,"腎臓食",null,null,null,null,null,null,null,null,"食",null,null,"肝臓食",null,null,null,null,null,null,null,null,null,"食",null,null,"糖尿食",null,null,null,null,null,null,null,null,"食"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"胃潰瘍食",null,null,null,null,null,null,null,null,"食",null,null,"貧血食",null,null,null,null,null,null,null,null,null,"食",null,null,"膵臓食",null,null,null,null,null,null,null,null,"食"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"脂質異常症食",null,null,null,null,null,null,null,null,"食",null,null,"痛風食",null,null,null,null,null,null,null,null,null,"食"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特別な場合の検査食",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"食",null,"心臓疾患等の減塩食",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"食"]
[]
[null,3,null,"栄養関係加算",null,null,null,null,null,null,"（当年度5月分）"]
[null,null,null,"栄養マネジメント強化加算",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,"再入所時栄養連携加算",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"療養食加算",null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,null,"経口移行加算",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,"経口維持加算（Ⅰ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,null,"経口維持加算（Ⅱ）",null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[null,null,null,"口腔・栄養スクリーニング加算",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人",null,"退所時栄養情報連携加算",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
[]
[null,4,null,"栄養ケア・マネジメント",null,null,null,null,null,null,null,null,null,null,"（当年度5月15日現在）",null,null,null,null,null,null,null,null,null,null,null,null,null,"低リスク",null,null,null,null,"人",null,null,null,null,null,"中リスク",null,null,null,null,"人",null,null,null,null,null,"高リスク",null,null,null,null,"人"]
[]
[null,5,null,"栄養摂取状況　（1人１日平均）",null,null,null,null,null,null,null,null,null,null,null,null,null,"（当年度5月分及び直近月）"]
[]
[null,null,"・","施設基準の作成年月",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,null,"〔日本人の食事摂取基準",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年版を参考〕"]
[]
[null,null,"・","食種名",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,"〔日本標準食品成分表",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年版を参考〕"]
[]
[null,null,"栄養素等名",null,null,null,null,null,null,"施設基準",null,null,null,null,null,null,"給与栄養量",null,null,null,null,null,null,null,null,null,null,null,null,null,"食品群名",null,null,null,null,null,null,null,"施設基準",null,null,null,null,null,null,"給与食品量"]
[null,null,null,null,null,null,null,null,null,"(給与栄養目標量)",null,null,null,null,null,null,null,null,"年","5月分",null,null,null,null,"年",null,null,"月分",null,null,null,null,null,null,null,null,null,null,"（食品構成）",null,null,null,null,null,null,null,null,"年","5月分",null,null,null,null,"年",null,null,"月分"]
[null,null,null,"エネルギー",null,null,null,null,null,null,null,null,null,null,"kcal",null,null,null,null,null,null,null,null,null,null,null,null,null,"kcal",null,"穀類",null,null,"米",null,null,null,null,null,null,null,null,null,"g",null,null,null,null,null,null,null,null,null,null,null,null,null,"g"]
[null,null,null,"たんぱく質",null,null,null,null,null,null,null,null,null,null,"g",null,null,null,null,null,null,null,null,null,null,null,null,null,"g",null,null,null,null,"小麦・麦",null,null,null,null,null,null,null,null,null,"g",null,null,null,null,null,null,null,null,null,null,null,null,null,"g"]
[null,null,null,"脂質",null,null,null,null,null,null,null,null,null,null,"g",null,null,null,null,null,null,null,null,null,null,null,null,null,"g",null,null,"いも類",null,null,null,null,null,null,null,null,null,null,null,"g",null,null,null,null,null,null,null,null,null,null,null,null,null,"g"]
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[null,null,"〇",null,"有",null,null,null,null,null,null,null,null,null,"日",3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"給水設備",null,null,null,"清掃・年号"]
[null,null,"×",null,"無",null,null,null,null,null,null,null,null,null,null,4,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"直結給水方式",null,null,null,"令和"]
[null,null,null,null,null,null,null,null,null,null,null,"②構成職種",null,"③目的",null,5,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受水槽方式・100％水道水",null,null,null,"平成"]
[null,null,"④実施回数",null,null,null,null,null,null,null,null,"〇",null,"〇",null,6,null,null,null,3,"非常食の対応",null,null,null,null,null,null,null,null,null,null,null,null,null,"受水槽方式・100％井水"]
[null,null,"年",1,null,"契約・年号",null,null,null,null,null,"×",null,"×",null,7,null,null,null,null,"マニュアル等",null,"作成等年号",null,"作成状況",null,null,null,null,null,null,null,null,null,"受水槽方式・井水混合"]
[null,null,"月",2,null,"令和",null,null,null,null,null,null,null,null,null,8,null,null,null,null,"有",null,"令和",null,"作成"]
[null,null,"日",3,null,"平成",null,null,null,null,null,null,null,null,null,9,null,null,null,null,"無",null,"平成",null,"改訂",null,null,null,null,null,null,null,null,null,"循環式浴槽"]
[null,null,null,4,null,null,null,null,null,null,null,null,null,null,null,10,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"設置、記録の保管"]
[null,null,null,5,null,null,null,null,null,null,2,"個別対応の食事",null,null,null,11,null,null,null,null,"食料保管場所",null,null,null,"他施設連携",null,"連携",null,null,null,null,null,null,null,"有"]
[null,null,null,6,null,null,null,null,null,null,null,"〇",null,null,null,12,null,null,null,null,"集中配置",null,null,null,"有",null,"市内の同法人施設",null,null,null,null,null,null,null,"無"]
[null,null,null,7,null,null,null,null,null,null,null,"×",null,null,null,null,null,null,null,null,"分散配置",null,null,null,"無",null,"市内の別法人施設"]
[null,null,null,8,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",null,null,null,null,null,null,null,"浴槽の種類"]
[null,null,null,9,null,null,null,null,null,null,3,"検食記録",null,"検食者",null,null,null,null,null,"Ⅳ","衛生管理の状況",null,null,null,null,null,null,null,null,null,null,null,null,null,"一般浴槽（大浴槽）"]
[null,null,null,10,null,null,null,null,null,null,null,"有",null,"〇",null,null,null,null,null,1,"給食業務関係",null,null,null,null,null,null,null,null,null,null,null,null,null,"機械浴槽（ストレッチャー）"]
[null,null,null,11,null,null,null,null,null,null,null,"無",null,"×",null,null,null,null,null,null,"①検収記録",null,null,"検収項目・温度管理",null,null,null,null,null,null,null,null,null,null,"機械浴槽（チェア）"]
[null,null,null,12,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"有",null,null,"〇",null,null,null,null,null,null,null,null,null,null,"機械浴槽（その他）"]
[null,3,"調理を行う場所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"無",null,null,"×",null,null,null,null,null,null,null,null,null,null,"その他"]
[null,null,"①～③","有",null,null,null,null,null,null,4,"行事食、外食、外注"]
[null,null,null,"無",null,null,null,null,null,null,null,"実施回数",null,null,"本人負担",null,"実施状況",null,null,null,"検便・実施回数",null,"検査項目"]
[null,null,null,null,null,null,null,null,null,null,null,"年",1,null,"有",null,"朝食・昼食・夕食・間食",null,null,null,1,null,"〇",null,null,null,null,null,null,null,null,null,null,null,"その他の設備",null,null,"手洗い石けん、アルコール"]
[null,null,"調理行為",null,null,null,null,null,null,null,null,"月",2,null,"無",null,"朝食・昼食・夕食",null,null,null,2,null,"×",null,null,null,null,null,null,null,null,null,null,null,"ペーパータオル",null,null,"有"]
[null,null,"調理全体",null,null,null,null,null,null,null,null,"日",3,null,null,null,"朝食・昼食",null,null,null,3,null,null,null,null,null,null,null,null,null,null,null,null,null,"エアータオル",null,null,"無"]
[null,null,"再加熱・盛り付けのみ",null,null,null,null,null,null,null,null,null,4,null,null,null,"朝食・夕食",null,null,null,4,null,"ノロ・実施回数",null,null,null,null,null,null,null,null,null,null,null,"布タオル"]
[null,null,"盛り付けのみ",null,null,null,null,null,null,null,null,null,5,null,null,null,"昼食・夕食",null,null,null,5,null,"毎月",null,null,null,null,null,null,null,null,null,null,null,"その他"]
[null,null,"炊飯・湯茶のみ",null,null,null,null,null,null,null,null,null,6,null,null,null,"朝食のみ",null,null,null,6,null,"10～3月"]
[null,null,"湯茶のみ",null,null,null,null,null,null,null,null,null,7,null,null,null,"昼食のみ",null,null,null,7,null,"その他"]
[null,null,"その他",null,null,null,null,null,null,null,null,null,8,null,null,null,"夕食のみ",null,null,null,8]
[null,4,"調理方法",null,null,null,null,null,null,null,null,null,9,null,null,null,"間食のみ",null,null,null,9,null,"検便・対象者"]
[null,null,"施設内調理",null,null,null,null,null,null,null,null,null,10,null,null,null,"実施なし",null,null,null,10,null,"〇"]
[null,null,"施設外調理（クックチル等調理済食品の購入）",null,null,null,null,null,null,null,null,null,11,null,null,null,null,null,null,null,11,null,"×"]
[null,null,"施設外調理（他施設で当日調理したものを搬入）",null,null,null,null,null,null,null,null,null,12,null,"嗜好調査・調査方法",null,null,null,null,null,12]
[null,null,"施設内調理・施設外調理の両方を組み合わせている",null,null,null,null,null,null,null,null,null,null,null,"本人記入"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"職員聞き取り",null,null,null,null,null,"保存食"]
[null,null,"調理方式",null,"施設外調理②運搬方法、５④運搬方法",null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,"〇"]
[null,null,"〇",null,"〇",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"×"]
[null,null,"×",null,"×",null,null,null,null,null,null,null,null,null,"残食調査・調査方法"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個別に把握",null,null,null,null,null,"保存食の温度記録、手洗い場の設置、駆除作業等"]
[null,5,"他施設、事業所への配食・給食提供",null,null,null,null,null,null,null,null,null,null,null,"全体で把握（目視）",null,null,null,null,null,"有"]
[null,null,"有",null,"配食先施設",null,null,null,null,null,null,null,null,null,"全体で把握（計量）",null,null,null,null,null,"無"]
[null,null,"無",null,"同一建物内",null,null,null,null,null,null,null,null,null,"全体で把握（目視・計量）"]
[null,null,null,null,"同一敷地内の別棟",null,null,null,null,null,null,null,null,null,"その他",null,null,null,null,null,"手拭き"]
[null,null,null,null,"別敷地",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"ペーパータオル"]
[null,null,null,null,"その他",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"エアータオル"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"布タオル"]
[null,9,"職員食の提供",null,"10　届出状況",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他"]
[null,null,"提供あり",null,"届出済み"]
[null,null,"提供なし",null,"対象外"]
[null,null,null,null,"未届"]