+-------+---+----------+----------+---------+------------+---+---+------+
| Logo  | * |          |          |         |            |   |   | ![]  |
| del   | * |          |          |         |            |   |   | (med |
| e     | F |          |          |         |            |   |   | ia/i |
| stado | O |          |          |         |            |   |   | mage |
|       | R |          |          |         |            |   |   | 1.jp |
|       | M |          |          |         |            |   |   | eg){ |
|       | U |          |          |         |            |   |   | widt |
|       | L |          |          |         |            |   |   | h="0 |
|       | A |          |          |         |            |   |   | .759 |
|       | R |          |          |         |            |   |   | 7222 |
|       | I |          |          |         |            |   |   | 2222 |
|       | O |          |          |         |            |   |   | 2222 |
|       | D |          |          |         |            |   |   | 2in" |
|       | E |          |          |         |            |   |   | he   |
|       | E |          |          |         |            |   |   | ight |
|       | V |          |          |         |            |   |   | ="0. |
|       | A |          |          |         |            |   |   | 3680 |
|       | L |          |          |         |            |   |   | 5555 |
|       | U |          |          |         |            |   |   | 5555 |
|       | A |          |          |         |            |   |   | 5556 |
|       | C |          |          |         |            |   |   | in"} |
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|       | Ó |          |          |         |            |   |   |      |
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|       | S |          |          |         |            |   |   |      |
|       | A |          |          |         |            |   |   |      |
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|       | N |          |          |         |            |   |   |      |
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|       | F |          |          |         |            |   |   |      |
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|       | I |          |          |         |            |   |   |      |
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|       | S |          |          |         |            |   |   |      |
|       | * |          |          |         |            |   |   |      |
|       | * |          |          |         |            |   |   |      |
|       |   |          |          |         |            |   |   |      |
|       | * |          |          |         |            |   |   |      |
|       | * |          |          |         |            |   |   |      |
|       | P |          |          |         |            |   |   |      |
|       | a |          |          |         |            |   |   |      |
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|       | n |          |          |         |            |   |   |      |
|       | r |          |          |         |            |   |   |      |
|       | á |          |          |         |            |   |   |      |
|       | p |          |          |         |            |   |   |      |
|       | i |          |          |         |            |   |   |      |
|       | d |          |          |         |            |   |   |      |
|       | a |          |          |         |            |   |   |      |
|       | d |          |          |         |            |   |   |      |
|       | e |          |          |         |            |   |   |      |
|       | l |          |          |         |            |   |   |      |
|       | a |          |          |         |            |   |   |      |
|       | s |          |          |         |            |   |   |      |
|       | c |          |          |         |            |   |   |      |
|       | o |          |          |         |            |   |   |      |
|       | n |          |          |         |            |   |   |      |
|       | d |          |          |         |            |   |   |      |
|       | i |          |          |         |            |   |   |      |
|       | c |          |          |         |            |   |   |      |
|       | i |          |          |         |            |   |   |      |
|       | o |          |          |         |            |   |   |      |
|       | n |          |          |         |            |   |   |      |
|       | e |          |          |         |            |   |   |      |
|       | s |          |          |         |            |   |   |      |
|       | d |          |          |         |            |   |   |      |
|       | e |          |          |         |            |   |   |      |
|       | l |          |          |         |            |   |   |      |
|       | o |          |          |         |            |   |   |      |
|       | s |          |          |         |            |   |   |      |
|       | r |          |          |         |            |   |   |      |
|       | e |          |          |         |            |   |   |      |
|       | f |          |          |         |            |   |   |      |
|       | u |          |          |         |            |   |   |      |
|       | g |          |          |         |            |   |   |      |
|       | i |          |          |         |            |   |   |      |
|       | o |          |          |         |            |   |   |      |
|       | s |          |          |         |            |   |   |      |
|       | d |          |          |         |            |   |   |      |
|       | u |          |          |         |            |   |   |      |
|       | r |          |          |         |            |   |   |      |
|       | a |          |          |         |            |   |   |      |
|       | n |          |          |         |            |   |   |      |
|       | t |          |          |         |            |   |   |      |
|       | e |          |          |         |            |   |   |      |
|       | d |          |          |         |            |   |   |      |
|       | e |          |          |         |            |   |   |      |
|       | s |          |          |         |            |   |   |      |
|       | a |          |          |         |            |   |   |      |
|       | s |          |          |         |            |   |   |      |
|       | t |          |          |         |            |   |   |      |
|       | r |          |          |         |            |   |   |      |
|       | e |          |          |         |            |   |   |      |
|       | s |          |          |         |            |   |   |      |
|       | * |          |          |         |            |   |   |      |
|       | * |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| **I.  |   |          |          |         |            |   |   |      |
| DATOS |   |          |          |         |            |   |   |      |
| DE LA |   |          |          |         |            |   |   |      |
| AG    |   |          |          |         |            |   |   |      |
| ENCIA |   |          |          |         |            |   |   |      |
| QUE   |   |          |          |         |            |   |   |      |
| HACE  |   |          |          |         |            |   |   |      |
| LA    |   |          |          |         |            |   |   |      |
| EV    |   |          |          |         |            |   |   |      |
| ALUAC |   |          |          |         |            |   |   |      |
| IÓN** |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ¹N    |   |          |          |         | **^90^N    |   |   |      |
| ombre |   |          |          |         | ecesidades |   |   |      |
| de la |   |          |          |         | inmediatas |   |   |      |
| agenc |   |          |          |         | identi     |   |   |      |
| ia/or |   |          |          |         | ficadas:** |   |   |      |
| ganiz |   |          |          |         |  **Sí**  |   |   |      |
| ación |   |          |          |         | **No**     |   |   |      |
| \_    |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^2^No |   |          |          |         |            |   |   |      |
| mbre/ |   |          |          |         |            |   |   |      |
| cargo |   |          |          |         |            |   |   |      |
| del   |   |          |          |         |            |   |   |      |
| eval  |   |          |          |         |            |   |   |      |
| uador |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |          |         |            |   |   |      |
| 3^Tel |   |          |          |         |            |   |   |      |
| éfono |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_ - |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_ - |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| ^4^C  |   |          |          |         |            |   |   |      |
| orreo |   |          |          |         |            |   |   |      |
| e     |   |          |          |         |            |   |   |      |
| lectr |   |          |          |         |            |   |   |      |
| ónico |   |          |          |         |            |   |   |      |
| u     |   |          |          |         |            |   |   |      |
| otro  |   |          |          |         |            |   |   |      |
| medio |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| con   |   |          |          |         |            |   |   |      |
| tacto |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| **II. |   |          |          |         |            |   |   |      |
| TIPO  |   |          |          |         |            |   |   |      |
| DE    |   |          |          |         |            |   |   |      |
| INST  |   |          |          |         |            |   |   |      |
| ALACI |   |          |          |         |            |   |   |      |
| ONES, |   |          |          |         |            |   |   |      |
| N     |   |          |          |         |            |   |   |      |
| OMBRE |   |          |          |         |            |   |   |      |
| Y     |   |          |          |         |            |   |   |      |
| DATOS |   |          |          |         |            |   |   |      |
| DEL   |   |          |          |         |            |   |   |      |
| CENSO |   |          |          |         |            |   |   |      |
| (NS-  |   |          |          |         |            |   |   |      |
| No    |   |          |          |         |            |   |   |      |
| Sabe, |   |          |          |         |            |   |   |      |
| IND-I |   |          |          |         |            |   |   |      |
| nform |   |          |          |         |            |   |   |      |
| ación |   |          |          |         |            |   |   |      |
| No    |   |          |          |         |            |   |   |      |
| Di    |   |          |          |         |            |   |   |      |
| sponi |   |          |          |         |            |   |   |      |
| ble** |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^5    |   |          |          |         |            |   |   |      |
| ^Tipo |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| re    |   |          |          |         |            |   |   |      |
| fugio |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| Comu  |   |          |          |         |            |   |   |      |
| nitar |   |          |          |         |            |   |   |      |
| io/re |   |          |          |         |            |   |   |      |
| cuper |   |          |          |         |            |   |   |      |
| ación |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| N     |   |          |          |         |            |   |   |      |
| ecesi |   |          |          |         |            |   |   |      |
| dades |   |          |          |         |            |   |   |      |
| espec |   |          |          |         |            |   |   |      |
| iales |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| Otro  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| ^6^I  |   |          |          |         |            |   |   |      |
| nstal |   |          |          |         |            |   |   |      |
| acion |   |          |          |         |            |   |   |      |
| de la |   |          |          |         |            |   |   |      |
| CRA  |   |          |          |         |            |   |   |      |
| Sí   |   |          |          |         |            |   |   |      |
| No   |   |          |          |         |            |   |   |      |
| N     |   |          |          |         |            |   |   |      |
| S/IND |   |          |          |         |            |   |   |      |
| ^7^C  |   |          |          |         |            |   |   |      |
| ódigo |   |          |          |         |            |   |   |      |
| CRA   |   |          |          |         |            |   |   |      |
| \_\   |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^8^   |   |          |          |         |            |   |   |      |
| Fecha |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| ape   |   |          |          |         |            |   |   |      |
| rtura |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| /\_\_ |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| /\_\_ |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| (d    |   |          |          |         |            |   |   |      |
| /m/a) |   |          |          |         |            |   |   |      |
| ^9^   |   |          |          |         |            |   |   |      |
| Fecha |   |          |          |         |            |   |   |      |
| de la |   |          |          |         |            |   |   |      |
| evalu |   |          |          |         |            |   |   |      |
| ación |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| /\_\_ |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| /\_\_ |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| (d    |   |          |          |         |            |   |   |      |
| /m/a) |   |          |          |         |            |   |   |      |
| ^10   |   |          |          |         |            |   |   |      |
| ^Hora |   |          |          |         |            |   |   |      |
| de la |   |          |          |         |            |   |   |      |
| evalu |   |          |          |         |            |   |   |      |
| ación |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| :     |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
|  am  |   |          |          |         |            |   |   |      |
|  pm  |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^11^M |   |          |          |         |            |   |   |      |
| otivo |   |          |          |         |            |   |   |      |
| de la |   |          |          |         |            |   |   |      |
| evalu |   |          |          |         |            |   |   |      |
| ación |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| Antes |   |          |          |         |            |   |   |      |
| del   |   |          |          |         |            |   |   |      |
| i     |   |          |          |         |            |   |   |      |
| nicio |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| o     |   |          |          |         |            |   |   |      |
| perac |   |          |          |         |            |   |   |      |
| iones |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| In    |   |          |          |         |            |   |   |      |
| icial |   |          |          |         |            |   |   |      |
|  De  |   |          |          |         |            |   |   |      |
| r     |   |          |          |         |            |   |   |      |
| utina |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| Otro  |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^12^N |   |          |          |         |            |   |   |      |
| ombre |   |          |          |         |            |   |   |      |
| y     |   |          |          |         |            |   |   |      |
| d     |   |          |          |         |            |   |   |      |
| escri |   |          |          |         |            |   |   |      |
| pción |   |          |          |         |            |   |   |      |
| del   |   |          |          |         |            |   |   |      |
| lugar |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^13   |   |          |          |         |            |   |   |      |
| ^Dire |   |          |          |         |            |   |   |      |
| cción |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^14^C |   |          |          |         |            |   |   |      |
| iudad |   |          |          |         |            |   |   |      |
| /     |   |          |          |         |            |   |   |      |
| Co    |   |          |          |         |            |   |   |      |
| ndado |   |          |          |         |            |   |   |      |
| \_    |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| ^15^E |   |          |          |         |            |   |   |      |
| stado |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| ^16^C |   |          |          |         |            |   |   |      |
| ódigo |   |          |          |         |            |   |   |      |
| p     |   |          |          |         |            |   |   |      |
| ostal |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| ^17^L |   |          |          |         |            |   |   |      |
| atitu |   |          |          |         |            |   |   |      |
| d/Lon |   |          |          |         |            |   |   |      |
| gitud |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_/\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |          |         |            |   |   |      |
| 18^No |   |          |          |         |            |   |   |      |
| mbre/ |   |          |          |         |            |   |   |      |
| cargo |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| con   |   |          |          |         |            |   |   |      |
| tacto |   |          |          |         |            |   |   |      |
| en    |   |          |          |         |            |   |   |      |
| las   |   |          |          |         |            |   |   |      |
| i     |   |          |          |         |            |   |   |      |
| nstal |   |          |          |         |            |   |   |      |
| ación |   |          |          |         |            |   |   |      |
| \_    |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| ^19   |   |          |          |         |            |   |   |      |
| ^Tipo |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| i     |   |          |          |         |            |   |   |      |
| nstal |   |          |          |         |            |   |   |      |
| ación |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| Es    |   |          |          |         |            |   |   |      |
| cuela |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| Esta  |   |          |          |         |            |   |   |      |
| dio/C |   |          |          |         |            |   |   |      |
| entro |   |          |          |         |            |   |   |      |
| co    |   |          |          |         |            |   |   |      |
| nvenc |   |          |          |         |            |   |   |      |
| iones |   |          |          |         |            |   |   |      |
|      |   |          |          |         |            |   |   |      |
| Otro\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^2    |   |          |          |         |            |   |   |      |
| 0^Tel |   |          |          |         |            |   |   |      |
| éfono |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_ - |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_ - |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| ^2    |   |          |          |         |            |   |   |      |
| 1^Fax |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_ - |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_ - |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| \_\_  |   |          |          |         |            |   |   |      |
| ^22^C |   |          |          |         |            |   |   |      |
| orreo |   |          |          |         |            |   |   |      |
| e     |   |          |          |         |            |   |   |      |
| lectr |   |          |          |         |            |   |   |      |
| ónico |   |          |          |         |            |   |   |      |
| /otro |   |          |          |         |            |   |   |      |
| medio |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| cont  |   |          |          |         |            |   |   |      |
| acto\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^23^  |   |          |          |         |            |   |   |      |
| Censo |   |          |          |         |            |   |   |      |
| a     |   |          |          |         |            |   |   |      |
| ctual |   |          |          |         |            |   |   |      |
| \_\   |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| ^24   |   |          |          |         |            |   |   |      |
| ^Capa |   |          |          |         |            |   |   |      |
| cidad |   |          |          |         |            |   |   |      |
| est   |   |          |          |         |            |   |   |      |
| imada |   |          |          |         |            |   |   |      |
| \     |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| ^25^N |   |          |          |         |            |   |   |      |
| úmero |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| resid |   |          |          |         |            |   |   |      |
| entes |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| ^26^N |   |          |          |         |            |   |   |      |
| úmero |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| mie   |   |          |          |         |            |   |   |      |
| mbros |   |          |          |         |            |   |   |      |
| del   |   |          |          |         |            |   |   |      |
| pers  |   |          |          |         |            |   |   |      |
| onal/ |   |          |          |         |            |   |   |      |
| v     |   |          |          |         |            |   |   |      |
| olunt |   |          |          |         |            |   |   |      |
| arios |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
| \_\_\ |   |          |          |         |            |   |   |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| *     |   |          |          | **VIII. |            |   |   |      |
| *III. |   |          |          | D       |            |   |   |      |
| INS   |   |          |          | ESECHOS |            |   |   |      |
| TALAC |   |          |          | SÓLIDOS |            |   |   |      |
| IONES |   |          |          | GENE    |            |   |   |      |
| (NS-  |   |          |          | RADOS** |            |   |   |      |
| No    |   |          |          |         |            |   |   |      |
| Sabe, |   |          |          |         |            |   |   |      |
| IND-I |   |          |          |         |            |   |   |      |
| nform |   |          |          |         |            |   |   |      |
| ación |   |          |          |         |            |   |   |      |
| No    |   |          |          |         |            |   |   |      |
| Dis   |   |          |          |         |            |   |   |      |
| ponib |   |          |          |         |            |   |   |      |
| le)** |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^27   |   |          |  Sí    | ^66^C   |            |   |  |      |
| ^Daño |   |          | No      | antidad |            |   | S |      |
| e     |   |          | NS/IND   | suf     |            |   | í |      |
| struc |   |          |          | iciente |            |   |  |      |
| tural |   |          |          | de      |            |   | N |      |
|       |   |          |          | reci    |            |   | o |      |
|       |   |          |          | pientes |            |   |  |      |
|       |   |          |          | para    |            |   | N |      |
|       |   |          |          | basura  |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^28   |   |          |  Sí    | ^67^Sep |            |   |  |      |
| ^Pres |   |          | No      | aración |            |   | S |      |
| encia |   |          | NS/IND   | a       |            |   | í |      |
| de    |   |          |          | decuada |            |   |  |      |
| per   |   |          |          |         |            |   | N |      |
| sonal |   |          |          |         |            |   | o |      |
| de    |   |          |          |         |            |   |  |      |
| segur |   |          |          |         |            |   | N |      |
| idad/ |   |          |          |         |            |   | S |      |
| orden |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | ^68^    |            |   |  |      |
| 29^Si |   |          | No      | Desecho |            |   | S |      |
| stema |   |          | NS/IND   | a       |            |   | í |      |
| de    |   |          |          | decuado |            |   |  |      |
| agua  |   |          |          |         |            |   | N |      |
| en    |   |          |          |         |            |   | o |      |
| ser   |   |          |          |         |            |   |  |      |
| vicio |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^30   |   |          |  Sí    | ^69^    |            |   |  |      |
| ^Agua |   |          | No      | Almacen |            |   | S |      |
| cal   |   |          | NS/IND   | amiento |            |   | í |      |
| iente |   |          |          | a       |            |   |  |      |
|       |   |          |          | decuado |            |   | N |      |
|       |   |          |          |         |            |   | o |      |
|       |   |          |          |         |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | ^70^R   |            |   |  |      |
| 31^Si |   |          | No      | emoción |            |   | S |      |
| stema |   |          | NS/IND   | a       |            |   | í |      |
| HVAC  |   |          |          | tiempo  |            |   |  |      |
| en    |   |          |          |         |            |   | N |      |
| ser   |   |          |          |         |            |   | o |      |
| vicio |   |          |          |         |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^32^V |   |          |  Sí    | ^7      |  Sólidos  |   |   |      |
| entil |   |          | No      | 1^Tipos |           |   |   |      |
| ación |   |          | NS/IND   | de      | Peligrosos |   |   |      |
| ade   |   |          |          | d       |  Médicos  |   |   |      |
| cuada |   |          |          | esechos |  NS/IND   |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | **IX.   |            |   |   |      |
| 33^Es |   |          | No      | ÁREA DE |            |   |   |      |
| pacio |   |          | NS/IND   | GU      |            |   |   |      |
| sufic |   |          |          | ARDERÍA |            |   |   |      |
| iente |   |          |          | DE      |            |   |   |      |
| por   |   |          |          | NIÑOS** |            |   |   |      |
| pe    |   |          |          |         |            |   |   |      |
| rsona |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^34^  |   |          |  Sí    | ^7      |            |   |  |      |
| Libre |   |          | No      | 2^Áreas |            |   | S |      |
| de    |   |          | NS/IND   | limpias |            |   | í |      |
| ri    |   |          |          | para el |            |   |  |      |
| esgos |   |          |          | cambio  |            |   | N |      |
| ocu   |   |          |          | de      |            |   | o |      |
| pacio |   |          |          | pañales |            |   |  |      |
| nales |   |          |          |         |            |   | N |      |
| y de  |   |          |          |         |            |   | S |      |
| les   |   |          |          |         |            |   | / |      |
| iones |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^35^  |   |          |  Sí    | ^7      |            |   |  |      |
| Libre |   |          | No      | 3^Áreas |            |   | S |      |
| de    |   |          | NS/IND   | para    |            |   | í |      |
| prob  |   |          |          | lavarse |            |   |  |      |
| lemas |   |          |          | las     |            |   | N |      |
| de    |   |          |          | manos   |            |   | o |      |
| p     |   |          |          |         |            |   |  |      |
| lagas |   |          |          |         |            |   | N |      |
| y     |   |          |          |         |            |   | S |      |
| vec   |   |          |          |         |            |   | / |      |
| tores |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^36^  |   |          |  Sí    | ^74^    |            |   |  |      |
| Nivel |   |          | No      | Higiene |            |   | S |      |
| acep  |   |          | NS/IND   | a       |            |   | í |      |
| table |   |          |          | decuada |            |   |  |      |
| de    |   |          |          | de      |            |   | N |      |
| lim   |   |          |          | j       |            |   | o |      |
| pieza |   |          |          | uguetes |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | ^75^J   |            |   |  |      |
| 37^Si |   |          | No      | uguetes |            |   | S |      |
| stema |   |          | NS/IND   | no      |            |   | í |      |
| eléc  |   |          |          | pel     |            |   |  |      |
| trico |   |          |          | igrosos |            |   | N |      |
| en    |   |          |          |         |            |   | o |      |
| ser   |   |          |          |         |            |   |  |      |
| vicio |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^38   |   |          |  Sí    | ^       |            |   |  |      |
| ^Gene |   |          | No      | 76^Área |            |   | S |      |
| rador |   |          | NS/IND   | de      |            |   | í |      |
| en    |   |          |          | prep    |            |   |  |      |
| opera |   |          |          | aración |            |   | N |      |
| ción, |   |          |          | de      |            |   | o |      |
| ^39^  |   |          |          | al      |            |   |  |      |
| Ti    |   |          |          | imentos |            |   | N |      |
| po\_\ |   |          |          | y       |            |   | S |      |
| _\_\_ |   |          |          | bi      |            |   | / |      |
| \_\_\ |   |          |          | berones |            |   | I |      |
| _\_\_ |   |          |          | limpia  |            |   | N |      |
| \_\_\ |   |          |          |         |            |   | D |      |
| _\_\_ |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^40^T |   |          | Sí No   | ^77^Pro |            |   |  |      |
| emper |   |          | NS/IND   | porción |            |   | S |      |
| atura |   |          |          | a       |            |   | í |      |
| int   |   |          |          | decuada |            |   |  |      |
| erior |   |          |          | niños/p |            |   | N |      |
| \_\   |   |          |          | ersonas |            |   | o |      |
| _\_\_ |   |          |          | enc     |            |   |  |      |
| \_\_\ |   |          |          | argadas |            |   | N |      |
| _\_\_ |   |          |          |         |            |   | S |      |
| ^o^F  |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| **IV. |   |          |          | ^7      |            |   |  |      |
| A     |   |          |          | 8^Nivel |            |   | S |      |
| LIMEN |   |          |          | ac      |            |   | í |      |
| TOS** |   |          |          | eptable |            |   |  |      |
|       |   |          |          | de      |            |   | N |      |
|       |   |          |          | l       |            |   | o |      |
|       |   |          |          | impieza |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | **X.    |            |   |   |      |
| 41^Se |   |          | No      | ÁREA    |            |   |   |      |
| pre   |   |          | NS/IND   | PARA    |            |   |   |      |
| paran |   |          |          | D       |            |   |   |      |
| en    |   |          |          | ORMIR** |            |   |   |      |
| las   |   |          |          |         |            |   |   |      |
| ins   |   |          |          |         |            |   |   |      |
| talac |   |          |          |         |            |   |   |      |
| iones |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | ^79^C   |            |   |  |      |
| 42^Se |   |          | No      | antidad |            |   | S |      |
| s     |   |          | NS/IND   | suf     |            |   | í |      |
| irven |   |          |          | iciente |            |   |  |      |
| en    |   |          |          | de      |            |   | N |      |
| las   |   |          |          | cat     |            |   | o |      |
| ins   |   |          |          | res/cam |            |   |  |      |
| talac |   |          |          | as/colc |            |   | N |      |
| iones |   |          |          | honetas |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^43   |   |          |  Sí    | ^80^Suf |            |   |  |      |
| ^Alim |   |          | No      | iciente |            |   | S |      |
| entos |   |          | NS/IND   | ropa de |            |   | í |      |
| prov  |   |          |          | cama    |            |   |  |      |
| ienen |   |          |          |         |            |   | N |      |
| de    |   |          |          |         |            |   | o |      |
| una   |   |          |          |         |            |   |  |      |
| f     |   |          |          |         |            |   | N |      |
| uente |   |          |          |         |            |   | S |      |
| s     |   |          |          |         |            |   | / |      |
| egura |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^44^S |   |          |  Sí    | ^81^La  |            |   |  |      |
| umini |   |          | No      | ropa de |            |   | S |      |
| stros |   |          | NS/IND   | cama se |            |   | í |      |
| s     |   |          |          | cambia  |            |   |  |      |
| ufici |   |          |          | con     |            |   | N |      |
| entes |   |          |          | regu    |            |   | o |      |
|       |   |          |          | laridad |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^45   |   |          |  Sí    | ^82^    |            |   |  |      |
| ^Alma |   |          | No      | Espacio |            |   | S |      |
| cenam |   |          | NS/IND   | suf     |            |   | í |      |
| iento |   |          |          | iciente |            |   |  |      |
| ade   |   |          |          |         |            |   | N |      |
| cuado |   |          |          |         |            |   | o |      |
|       |   |          |          |         |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | ^8      |            |   |  |      |
| 46^Te |   |          | No      | 3^Nivel |            |   | S |      |
| mpera |   |          | NS/IND   | ac      |            |   | í |      |
| turas |   |          |          | eptable |            |   |  |      |
| adec  |   |          |          | de      |            |   | N |      |
| uadas |   |          |          | l       |            |   | o |      |
|       |   |          |          | impieza |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^47^  |   |          |  Sí    | **XI.   |            |   |   |      |
| Áreas |   |          | No      | A       |            |   |   |      |
| para  |   |          | NS/IND   | NIMALES |            |   |   |      |
| la    |   |          |          | DE      |            |   |   |      |
| varse |   |          |          | COM     |            |   |   |      |
| las   |   |          |          | PAÑÍA** |            |   |   |      |
| manos |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^48^M |   |          |  Sí    | ^84^    |            |   |  |      |
| anejo |   |          | No      | A       |            |   | S |      |
| higi  |   |          | NS/IND   | nimales |            |   | í |      |
| énico |   |          |          | de      |            |   |  |      |
| de    |   |          |          | c       |            |   | N |      |
| los   |   |          |          | ompañía |            |   | o |      |
| alim  |   |          |          | p       |            |   |  |      |
| entos |   |          |          | resente |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^49^  |   |          |  Sí    | ^85^A   |            |   |  |      |
| Áreas |   |          | No      | tención |            |   | S |      |
| para  |   |          | NS/IND   | dis     |            |   | í |      |
| lavar |   |          |          | ponible |            |   |  |      |
| los   |   |          |          | para    |            |   | N |      |
| p     |   |          |          | a       |            |   | o |      |
| latos |   |          |          | nimales |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^50   |   |          |  Sí    | ^       |            |   |  |      |
| ^Área |   |          | No      | 86^Área |            |   | S |      |
| de la |   |          | NS/IND   | de      |            |   | í |      |
| c     |   |          |          | signada |            |   |  |      |
| ocina |   |          |          | para    |            |   | N |      |
| l     |   |          |          | a       |            |   | o |      |
| impia |   |          |          | nimales |            |   |  |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| **V.  |   |          |          | ^8      |            |  |   |      |
| AGUA  |   |          |          | 7^Nivel |            | S |   |      |
| PARA  |   |          |          | ac      |            | í |   |      |
| BEBER |   |          |          | eptable |            |  |   |      |
| Y     |   |          |          | de      |            | N |   |      |
| HI    |   |          |          | l       |            | o |   |      |
| ELO** |   |          |          | impieza |            |  |   |      |
|       |   |          |          |         |            | N |   |      |
|       |   |          |          |         |            | S |   |      |
|       |   |          |          |         |            | / |   |      |
|       |   |          |          |         |            | I |   |      |
|       |   |          |          |         |            | N |   |      |
|       |   |          |          |         |            | D |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^51^S |   |          |  Sí    | **XII.  |            |   |   |      |
| umini |   |          | No      | OTRAS   |            |   |   |      |
| stros |   |          | NS/IND   | CON     |            |   |   |      |
| s     |   |          |          | SIDERAC |            |   |   |      |
| ufici |   |          |          | IONES** |            |   |   |      |
| entes |   |          |          |         |            |   |   |      |
| de    |   |          |          |         |            |   |   |      |
| agua  |   |          |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^52^S |   |          |  Sí    | ^88     |            |   |  |      |
| umini |   |          | No      | ^Acceso |            |   | S |      |
| stros |   |          | NS/IND   | para    |            |   | í |      |
| s     |   |          |          | p       |            |   |  |      |
| ufici |   |          |          | ersonas |            |   | N |      |
| entes |   |          |          | discapa |            |   | o |      |
| de    |   |          |          | citadas |            |   |  |      |
| hielo |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | S |      |
|       |   |          |          |         |            |   | / |      |
|       |   |          |          |         |            |   | I |      |
|       |   |          |          |         |            |   | N |      |
|       |   |          |          |         |            |   | D |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | ^8      |            |  |   |      |
| 53^El |   |          | No      | 9^Áreas |            | S |   |      |
| agua  |   |          | NS/IND   | des     |            | í |   |      |
| pro   |   |          |          | ignadas |            |  |   |      |
| viene |   |          |          | para    |            | N |   |      |
| de    |   |          |          | fumar   |            | o |   |      |
| una   |   |          |          |         |            |  |   |      |
| f     |   |          |          |         |            | N |   |      |
| uente |   |          |          |         |            | S |   |      |
| s     |   |          |          |         |            | / |   |      |
| egura |   |          |          |         |            | I |   |      |
|       |   |          |          |         |            | N |   |      |
|       |   |          |          |         |            | D |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |          |  Sí    | **XIII. |            |   |   |      |
| 54^El |   |          | No      | COME    |            |   |   |      |
| hielo |   |          | NS/IND   | NTARIOS |            |   |   |      |
| pro   |   |          |          | *(Liste |            |   |   |      |
| viene |   |          |          | nece    |            |   |   |      |
| de    |   |          |          | sidades |            |   |   |      |
| una   |   |          |          | c       |            |   |   |      |
| f     |   |          |          | ríticas |            |   |   |      |
| uente |   |          |          | en hoja |            |   |   |      |
| s     |   |          |          | de      |            |   |   |      |
| egura |   |          |          | nece    |            |   |   |      |
|       |   |          |          | sidades |            |   |   |      |
|       |   |          |          | inmedia |            |   |   |      |
|       |   |          |          | tas)*** |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| **VI. |   |          |          | \_\_\_  |            |   |   |      |
| MÉDI  |   |          |          | \_\_\_\ |            |   |   |      |
| CO/SA |   |          |          | _\_\_\_ |            |   |   |      |
| LUD** |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^55^B |   |          |  Sí    | \_\_\_  |            |   |   |      |
| rotes |   |          | No      | \_\_\_\ |            |   |   |      |
| de    |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| en    |   |          |          | \_\_\_\ |            |   |   |      |
| ferme |   |          |          | _\_\_\_ |            |   |   |      |
| dades |   |          |          | \_\_\_\ |            |   |   |      |
| poco  |   |          |          | _\_\_\_ |            |   |   |      |
| co    |   |          |          | \_\_\_\ |            |   |   |      |
| munes |   |          |          | _\_\_\_ |            |   |   |      |
| y     |   |          |          | \_\_\_\ |            |   |   |      |
| viol  |   |          |          | _\_\_\_ |            |   |   |      |
| encia |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^56   |   |          |  Sí    | \_\_\_  |            |   |   |      |
| ^Serv |   |          | No      | \_\_\_\ |            |   |   |      |
| icios |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| de    |   |          |          | \_\_\_\ |            |   |   |      |
| ate   |   |          |          | _\_\_\_ |            |   |   |      |
| nción |   |          |          | \_\_\_\ |            |   |   |      |
| m     |   |          |          | _\_\_\_ |            |   |   |      |
| édica |   |          |          | \_\_\_\ |            |   |   |      |
| en    |   |          |          | _\_\_\_ |            |   |   |      |
| las   |   |          |          | \_\_\_\ |            |   |   |      |
| ins   |   |          |          | _\_\_\_ |            |   |   |      |
| talac |   |          |          | \_\_\_\ |            |   |   |      |
| iones |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^57   |   |          |  Sí    | \_\_\_  |            |   |   |      |
| ^Serv |   |          | No      | \_\_\_\ |            |   |   |      |
| icios |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| de    |   |          |          | \_\_\_\ |            |   |   |      |
| conse |   |          |          | _\_\_\_ |            |   |   |      |
| jería |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| *     |   |          |          | \_\_\_  |            |   |   |      |
| *VII. |   |          |          | \_\_\_\ |            |   |   |      |
| C     |   |          |          | _\_\_\_ |            |   |   |      |
| ONDIC |   |          |          | \_\_\_\ |            |   |   |      |
| IONES |   |          |          | _\_\_\_ |            |   |   |      |
| SA    |   |          |          | \_\_\_\ |            |   |   |      |
| NITAR |   |          |          | _\_\_\_ |            |   |   |      |
| IAS** |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^5    |   |          |  Sí    | \_\_\_  |            |   |   |      |
| 8^Ser |   |          | No      | \_\_\_\ |            |   |   |      |
| vicio |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| de    |   |          |          | \_\_\_\ |            |   |   |      |
| lavan |   |          |          | _\_\_\_ |            |   |   |      |
| dería |   |          |          | \_\_\_\ |            |   |   |      |
| ade   |   |          |          | _\_\_\_ |            |   |   |      |
| cuado |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^5    |   |          |  Sí    | \_\_\_  |            |   |   |      |
| 9^Can |   |          | No      | \_\_\_\ |            |   |   |      |
| tidad |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| sufic |   |          |          | \_\_\_\ |            |   |   |      |
| iente |   |          |          | _\_\_\_ |            |   |   |      |
| de    |   |          |          | \_\_\_\ |            |   |   |      |
| ino   |   |          |          | _\_\_\_ |            |   |   |      |
| doros |   |          |          | \_\_\_\ |            |   |   |      |
| en    |   |          |          | _\_\_\_ |            |   |   |      |
| ser   |   |          |          | \_\_\_\ |            |   |   |      |
| vicio |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^6    |   |          |  Sí    | \_\_\_  |            |   |   |      |
| 0^Can |   |          | No      | \_\_\_\ |            |   |   |      |
| tidad |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| sufic |   |          |          | \_\_\_\ |            |   |   |      |
| iente |   |          |          | _\_\_\_ |            |   |   |      |
| de    |   |          |          | \_\_\_\ |            |   |   |      |
| d     |   |          |          | _\_\_\_ |            |   |   |      |
| uchas |   |          |          | \_\_\_\ |            |   |   |      |
| en    |   |          |          | _\_\_\_ |            |   |   |      |
| ser   |   |          |          | \_\_\_\ |            |   |   |      |
| vicio |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^6    |   |          |  Sí    | \_\_\_  |            |   |   |      |
| 1^Can |   |          | No      | \_\_\_\ |            |   |   |      |
| tidad |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| sufic |   |          |          | \_\_\_\ |            |   |   |      |
| iente |   |          |          | _\_\_\_ |            |   |   |      |
| de    |   |          |          | \_\_\_\ |            |   |   |      |
| lava  |   |          |          | _\_\_\_ |            |   |   |      |
| manos |   |          |          | \_\_\_\ |            |   |   |      |
| en    |   |          |          | _\_\_\_ |            |   |   |      |
| ser   |   |          |          | \_\_\_\ |            |   |   |      |
| vicio |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^62   |   |          |  Sí    | \_\_\_  |            |   |   |      |
| ^Prod |   |          | No      | \_\_\_\ |            |   |   |      |
| uctos |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| para  |   |          |          | \_\_\_\ |            |   |   |      |
| la    |   |          |          | _\_\_\_ |            |   |   |      |
| hi    |   |          |          | \_\_\_\ |            |   |   |      |
| giene |   |          |          | _\_\_\_ |            |   |   |      |
| y el  |   |          |          | \_\_\_\ |            |   |   |      |
| l     |   |          |          | _\_\_\_ |            |   |   |      |
| avado |   |          |          | \_\_\_\ |            |   |   |      |
| de    |   |          |          | _\_\_\_ |            |   |   |      |
| las   |   |          |          | \_\_\_\ |            |   |   |      |
| manos |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^63   |   |          |  Sí    | \_\_\_  |            |   |   |      |
| ^Artí |   |          | No      | \_\_\_\ |            |   |   |      |
| culos |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| de    |   |          |          | \_\_\_\ |            |   |   |      |
| hi    |   |          |          | _\_\_\_ |            |   |   |      |
| giene |   |          |          | \_\_\_\ |            |   |   |      |
| sani  |   |          |          | _\_\_\_ |            |   |   |      |
| taria |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^64^  |   |          |  Sí    | \_\_\_  |            |   |   |      |
| Nivel |   |          | No      | \_\_\_\ |            |   |   |      |
| acep  |   |          | NS/IND   | _\_\_\_ |            |   |   |      |
| table |   |          |          | \_\_\_\ |            |   |   |      |
| de    |   |          |          | _\_\_\_ |            |   |   |      |
| lim   |   |          |          | \_\_\_\ |            |   |   |      |
| pieza |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
|       |   |          |          | \_\_\_\ |            |   |   |      |
|       |   |          |          | _\_\_\_ |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+
| ^     |   |         |          |         |            |   |   |      |
| 65^Si |   | Com      |          |         |            |   |   |      |
| stema |   | unitario |          |         |            |   |   |      |
| de    |   |  En el  |          |         |            |   |   |      |
| aguas |   | lugar   |          |         |            |   |   |      |
| n     |   | Portátil |          |         |            |   |   |      |
| egras |   |  NS/IND |          |         |            |   |   |      |
+-------+---+----------+----------+---------+------------+---+---+------+

  ---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
  **XIV. HOJA DE NECESIDADES   
  INMEDIATAS**                 

  **Área \#**                  **Descripción**

  \_\_\_\_\_\_\_\_\_\_\_\_\_   \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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  \_\_\_\_\_\_\_\_\_\_\_\_\_   \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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