zilongwang/ReadingBank huggingface dataset:
Component Reference Component Approved Safe Life Carried Out Next Due Part Number Fatigue Hours Hours Date Hours Date Pt wing lower spar boom CAA AD G-2012-0001/ TNS 138 n/a 30,000 n/a Pt wing root inserts CAA AD G-2012-0001/ TNS 138 Aluminium inserts (TNS 160 carried out <5000 fatigue hrs) 8,000 n/a Aluminium inserts (TNS 160 carried out >5,000hrs) +3,000 from time TNS 160 carried out (but not exceeding 17,500) n/a Steel inserts (post-mod H.289) 22,000 n/a Stbd wing attachment links CAA AD G-2012-0001/ TNS 138 C1-W-493 15,000 n/a Stbd wing attachment bolts CAA AD G-2012-0001/ TNS 138 C1-W-491 C1-W-495 15,000 n/a Stbd wing lower spar boom CAA AD G-2012-0001/ TNS 138 n/a 30,000 n/a Stbd wing root inserts CAA AD G-2012-0001/ TNS 138 Aluminium inserts (TNS 160 carried out <5000 fatigue hrs) 8,000 n/a Aluminium inserts (TNS 160 carried out >5,000hrs) +3,000 from time TNS 160 carried out (but not exceeding 17,500) n/a Steel inserts (post-mod H.289) 22,000 n/a Tailplane attachment brackets CAA AD G-2012-0001/ TNS 138 C1-TP-167 C1-TP-313 9,984 n/a Page 2 of 5
Description Reference Periodicity (whichever occurs first) Carried Out Next Due Hours Calendar Hours Date Hours Date Mandatory life limits (X-refer TNS 138) CAA AD G-2012-0001/ TNS 138 n/a 12 months n/a Tailplane attachment brackets (aluminium alloy type) CAA AD G-2013-0002/ TNS 209 n/a 6 months n/a Pressure testing of induction manifold heater box (Gipsy Major engines) CAA AD 1776 PRE 80/ TNS GM10N.47 n/a 12 months n/a Propeller: Fairey Reed (strip and examination) CAA AD 2220 PRE 80 300 hours n/a n/a 3 NON-MANDATORY INSPECTIONS (REFERENCE ONLY) The following non-mandatory inspections are included for reference purposes only (further information and TNS list is included in TADS 950): Engine overhaul: Gipsy Major RR TNS GE 30 1500 hrs 20 years 4 MAINTENANCE MAINTENANCE SCHEDULE The aircraft is being maintained to the following schedule as specified in TADS 950: MAINTENANCE MANUAL The aircraft is being maintained in accordance with the following Maintenance Manual: Reference Number Issue/ Revision Date 5 PILOT’S OPERATING HANDBOOK The Pilot’s Operating Handbook is to the following standard and revision status: Reference Number Issue/ Revision Supplement Date Page 4 of 5
Study short title Ethics No. R&D No. RHM Principal Investigator Sponsor Site Study Specific Document Log Subject study ID Subject initials Date of consent (dd/mmm/yyy) Participant Information Sheet Signed Informed Consent Form GP Letter Version no. Copy given to subject * Copy in medical records * Version no. Copy given to subject * Copy in medical records * Original in Site File * Version no. Sent to GP * Copy in medical records * * Insert staff initials (and date if different from the date of consent) Page of
Study short title Ethics No. R&D No. RHM Principal Investigator Sponsor Site Drug Accountability Log Drug name and strength: ________________________________________ Drug storage location: ________________________________________ Date received Time received Batch Number Quantity received Staff signature Quantity removed Running Total Date removed Study ID of subject issued to (or ‘Returned to Pharmacy’) Staff signature Notes (include details of any drug returns etc) Page of
Criterion Program Comments Evidence (Link or include with application submission) A certificate/diploma is granted by the educational institution. Examples of Evidence: Official documentation from the educational institution identifying the diploma/certificate awarded upon completion of the program. The education program is affiliated with an institution authorized under applicable law to provide postsecondary education. Examples of Evidence: Identify the agency from which the institution has the authority to offer educational programs at the postsecondary level and provide verification of this authority. The individual responsible for the education program applying for Candidacy Status (typically the Program Coordinator) is an occupational therapist or physiotherapist registered with no conditions with the appropriate provincial regulatory body. Examples of Evidence: Provide proof of registration of the program
URINARY PROBLEMS The following questions are about going to the toilet for a wee. This is also called voiding. Some women sometimes feel a sudden, overwhelming need to go to the toilet. This is called urgency. For each of the following questions, please circle the answer that best describes how you feel. 0 1 2 3 4 1 How many times do you void (go for a wee) during waking hours? 3-6 7-10 11-14 15-19 20+ 2a How many times do you void at night? 0 1 2 3 4+ 2b If you get up at night, to what extent does it usually bother you? Never Mildly Severe 3 Are you currently sexually active? Yes No 4a IF YOU ARE SEXUALLY ACTIVE, do you now, or have you ever had, pain or urgency to urinate during or after sexual intercourse? Never Occasionally Usually Always 4b Has the pain or urgency ever made you avoid sexual intercourse? Never Occasionally Usually Always 5 Do you have pain associated with your bladder or in your pelvis, vagina, lower abdomen, urethra (the opening from which you wee) or perineum (the area between your front and back passage)? Never Occasionally Usually Always 6 Do you still have urgency shortly after urinating? Never Occasionally Usually Always 7a When you have pain, is it usually? Mild Moderate Severe 7b How often does this pain bother you? Never Occasionally Usually Always 8a When you have urgency, it is usually? Mild Moderate Severe 8b How often does this bother you? Never Occasionally Usually Always Parsons C.L. J Reprod Med 2004;49(Supplement 3):235-42. Yes No Do you suffer from pain when your bladder is filling?
CW LLC & Employment Application We are an equal opportunity employer and do not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, national origin, age, sex, marital status, disability or handicap, protected veteran status, or any other characteristic protected by federal or state law. Last Name First M.I. Date Street Address Apartment/Unit # City State ZIP Phone E-mail Address Date Available Social Security No. Desired Salary Position Applied for Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO Have you ever worked for this company? YES NO If so, when? Have you ever been convicted of a felony? A YES answer is not an absolute bar to employment, but will only be considered in relation to specific job requirements. YES NO If yes, explain Are you over the age of 18? YES NO High School Address From To Did you graduate? YES NO Degree College Address From To Did you graduate? YES NO Degree Other Address From To Did you graduate? YES NO Degree Please list three professional references. Full Name Relationship Company Phone Address
Full Name Relationship Company Phone Address Full Name Relationship Company Phone Address Company Phone Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Company Phone Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Company Phone Address Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Branch From To Rank at Discharge
CW LLC Employment Application We are an equal opportunity employer and do not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, national origin, age, sex, marital status, disability or handicap, protected veteran status, or any other characteristic protected by federal or state law. Last Name First M.I. Date Street Address Apartment/Unit # City State ZIP Phone E-mail Address Date Available Social Security No. Desired Salary Position Applied for Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO Have you ever worked for this company? YES NO If so, when? Have you ever been convicted of a felony? A YES answer is not an absolute bar to employment, but will only be considered in relation to specific job requirements. YES NO If yes, explain Are you over the age of 18? YES NO High School Address From To Did you graduate? YES NO Degree College Address From To Did you graduate? YES NO Degree Other Address From To Did you graduate? YES NO Degree Please list three professional references. Full Name Relationship Company Phone Address Full Name Relationship
Company Phone Address Full Name Relationship Company Phone Address Company Phone Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Company Phone Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Company Phone Address Job Title Starting Salary $ Ending Salary $ Responsibilities From To Reason for Leaving May we contact your previous supervisor for a reference? YES NO Branch From To Rank at Discharge
Referral for Access Assessment into Inpatient Services for Children & Young People PART A: ALL FIELDS TO BE COMPLETED BY CAMHS T3 CLINICAN, EXISTING INPATIENT SERVICE or ADULT CRISIS TEAM Referral Type (please circle relevant type) Emergency Response in 12 hrs; assessment in 24 hrs. Urgent Review and response within 48 hrs. Routine Review and respond within 1 week; assessment within 4 weeks The existing clinical team will retain responsibility for patient care until an admission into a CAMHS inpatient placement. Is there any restriction on sharing information? If so please give details: Yes☐ No ☐ Details: Personal Details Full name: Previous surnames: Address: Date of Birth: NHS No: Gender Religion: Ethnicity: Telephone No: First language: Special consideration for communications: CCG: GP name and address: Parent or guardian name: Address: Does the person above have parental responsibility? Yes No Name of person with parental responsibility: Contact telephone number: Legal Status at time of Referral Is the Child: tick as appropriate Yes No Currently detained under the Mental Health Act?If yes, what identify below: ☐ ☐ Under Section 136 ☐ ☐ Living with parent/carer with parental responsibility ☐ ☐ Voluntarily accommodated by the Local Authority (s20) ☐ ☐ Subject to Care Order (s 31) ☐ ☐ If s20 or s31, are they placed in: tick as appropriate Foster Care ☐ ☐ Residential Care ☐ ☐ With Parents ☐ ☐ Is the child subject of: Child in need plan ☐ ☐ Child Protection Plan ☐ ☐
PLEASE LIST ANY CONTACTS THAT YOU FEEL SHOULD BE KEPT INFORMED OF THIS YOUNG PERSON’S CASE AND INVITED TO MEETINGS SUCH AS CPAs. Primary community contact or care coordinator Social work contact Name: Job Title: Organisation: Telephone Number: Email Address: Name: Job Title: Organisation: Telephone Number: Email Address: Nearest relative (under the MHA) if different from next of kin Community psychiatrist Name: Job Title: Organisation: Telephone Number: Email Address: Name: Job Title: Organisation: Telephone Number: Email Address: Psychologist Dietician Name: Job Title: Organisation: Telephone Number: Email Address: Name: Job Title: Organisation: Telephone Number: Email Address: Family Therapy Other Name: Job Title: Organisation: Telephone Number: Email Address: Name: Job Title: Organisation: Telephone Number: Email Address:
INFORMATION ABOUT INTERESTED PERSONS AND OTHERS TO CONSULT Family member or friend Name Address Telephone Anyone named by the person as someone to be consulted about their welfare Name Address Telephone Anyone engaged in caring for the person or interested in their welfare Name Address Telephone Any donee of a Lasting Power of Attorney granted by the person Name Address Telephone Any Personal Welfare Deputy appointed for the person by the Court of Protection Name Address Telephone Any IMCA instructed in accordance with sections 37 to 39D of the Mental Capacity Act 2005 Name Address Telephone
INFORMATION ABOUT INTERESTED PERSONS AND OTHERS TO CONSULT Family member or friend Name Address Telephone Anyone named by the person as someone to be consulted about their welfare Name Address Telephone Anyone engaged in caring for the person or interested in their welfare Name Address Telephone Any donee of a Lasting Power of Attorney for Health and Welfare granted by the person Name Address Telephone Any Deputy for Health and Welfare appointed for the person by the Court of Protection Name Address Telephone Any IMCA instructed in accordance with sections 37 to 39D of the Mental Capacity Act 2005 Name Address Telephone
TALENTED AND GIFTED PROGRAM CHECKLIST Student’s Name Date sent Form Form# Date received Comments Behavioral Information – Teacher checklist Behavioral Information – Parent checklist Behavioral Information – Student checklist Referral – Teacher-Parent-Self Permission to Evaluate – Test Permission to Evaluate - Test Permission to Evaluate – Test Test Scores – Test Name Test Scores – Test Name Test Scores – Test Name State Test Scores Case Study Parent Notification Letter *Send home/one copy for file* Personal Education Plan
Important: The particulars to be given are those referred to in section 20(2)(a) of the Companies Act 1982 and section 143(1) of the Companies Act 1931. Please read the notes on the last page before completing this part of the form. The names and particulars of the persons who are to be the first directors of the company are as follows: Name (note 1): Former name(s) (note 2): Address (note 3): Occupation (note 4): Nationality and nationality of origin if different: Other directorship (note 4): I hereby consent to act as director of the company named on page 1: Dated: Name (note 1): Former name(s) (note 2): Address (note 3): Occupation (note 4): Nationality and nationality of origin if different: Other directorship (note 4): I hereby consent to act as director of the company named on page 1: Dated:
MANAGEMENT'S REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING The management of the Company is responsible for establishing and maintaining adequate internal control over financial reporting. The Company’s internal control over financial reporting is a process designed under the supervision of the Company’s Chief Executive Officer and Chief Financial Officer to provide reasonable assurance regarding the reliability of financial reporting and the preparation of the Company’s financial statements for external purposes in accordance with generally accepted accounting principles. As of December 31, 2016, management assessed the effectiveness of the Company’s internal control over financial reporting based on the criteria for effective internal control over financial reporting established in the 2013 “Internal Control - Integrated Framework,” issued by the Committee of Sponsoring Organizations of the Treadway Commission. Based on our assessment and those criteria, management determined that the Company maintained effective internal control over financial reporting at December 31, 2016. Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate. Grant Thornton LLP, the independent registered public accounting firm that audited the consolidated financial statements of the Company included in this annual report on Form 10-K, has issued their report on the effectiveness of the Company’s internal control over financial reporting at December 31, 2016. The report, which expresses an unqualified opinion on the effectiveness of the Company’s internal control over financial reporting at December 31, 2016, is included in this Item under the heading “Report of Independent Registered Public Accounting Firm.”
Karumba is situated on the coast at the southern end of Gulf of Carpentaria and is accessible by road from Cloncurry or via commercial flights from Cairns and Mt Isa. If travelling by road you are advised to check on specific road condition details - closures, roadworks, flooding and other road network information by calling Queensland Government Department of Main Roads on or on line at . All visitors are expected to make their own travel arrangements to Kurumba. Important Site Information Personal Protective Equipment (PPE) It is recommended that where ever possible you attend site with your own PPE, minimum PPE for site is: High visibility long sleeved shirt with reflective stripes; Long Pants; Steel toed lace up boots; Please bring the above minimum PPE requirements with you. If a hard hat, safety glasses and gloves are required they will be provided on arrival. There is only a limited supply of PPE kept on site. Health and Safety Awareness Inductions A visitor induction must be completed at NCR Training Room and is valid for 7 days. Whilst on site with a visitor’s induction you must be escorted by your site host at all times. If staying longer than 7 days or a frequent visitor to site you are required to complete a Full Site Induction. Please specify which you would like to complete so that appropriate time can be allocated. Hydration The weather through summer can be extreme and maintaining hydration is essential. Always ensure you travel with an adequate supply of water in your vehicle and regularly hydrate yourself. Potable Water from the site taps is safe for consumption and is available in crib rooms and the dry mess. Some symptoms of dehydration include headaches, nausea and dizziness. If you are feeling unwell, please always report your condition to your supervisor. Note: Please bring a refillable water bottle with you, we have filtered potable water dispensers onsite and want to reduce the number of disposable water bottles generated onsite. Medical You are responsible for bringing any medications you may need whilst on site and if you are taking any prescribed or over the counter medications you should notify your supervisor. You will be required to complete a medical declaration form on your arrival to site identifying key medical issues and allergies. Limited First aid and medical treatment is available at either of the site first aid rooms, one at the camp and one behind the main office building.
Case ID Number: DEPRIVATION OF LIBERTY SAFEGUARDS FORM 11 IMCA REFERRAL Full name of person being deprived of, or being assessed, to be deprived of liberty Name Name and address of the care home or hospital where the person is being deprived of, or being assessed to be deprived of liberty Name Address Person to contact at the care home or hospital, (include ward details if appropriate) Name Telephone Email Ward (if appropriate) Name of the Supervisory Body instructing the IMCA Name Contact person at Supervisory Body to receive IMCA submissions Name Telephone Email IMCA Service to which this referral is being made Name Address CONTACT DETAILS OF THE ASSESSORS Mental Health Assessor Name Telephone Email Best Interests Assessor Name Telephone Email
IN THE PROBATE COURT OF BIBB COUNTY STATE OF IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) CERTIFICATE OF SERVICE OF ORDER FOR SERVICE AND NOTICE OF PROCEEDINGS TO INTERESTED PARTIES [NOTE: Notice is required to be mailed to the spouse, family, and/or friends of the Proposed Ward as found in paragraphs 6, 7, 9, and 12 of the Petition.] I certify that I have on this date mailed in an envelope with proper postage affixed thereto for first-class delivery (unless otherwise noted) the “Notice of Filing of Petition for Guardianship and/or Conservatorship” and Order(s), to the following parties at the address listed below: This ______ day of ___________________________, 20____. ________________________________________________ Clerk of the Probate Court Bibb County Courthouse, Room 207 Probate P.O. Box 6518 Macon, GA 31208 (478) 621-6494
*Reporting authorities The following bodies are reporting authorities for the purposes of the application for this permit in relation to the matters set out below: Reporting authority Matter reported on or consented to Relevant regulation no. *Conditions to which this permit is subject Occupation is subject to the following conditions— (1) Essential safety measures The following essential safety measures must be inspected, tested and maintained in accordance with the maintenance requirements set out in the following table— Essential safety measures required to be provided in the building or place of public Provision of the Building 2018 applicable to installation and operation of essential safety measure The level of that each essential safety measure must achieve to fulfil its purpose The frequency and type of required for each essential safety measure The frequency and type of testing and required for each essential safety measure *(2) Other conditions *Combined allotment determination A determination has been made under regulation 64(1) of the Building Regulations 2018 in relation to the building to which this permit applies. *Subdivision of existing building The building to which this occupancy permit relates was created by the subdivision of an existing building. An exemption granted in accordance with regulation 231 exempts the building from compliance with certain provisions of the Building Regulations 2018. This exemption was granted by *a municipal building surveyor/*the private building surveyor on [insert date], and a copy of this exemption is available by request from the relevant council in accordance with regulation 51. Suitability for occupation At the date this occupancy permit is issued, the *building/*place of public entertainment to which this permit applies is suitable for occupation. Relevant building surveyor Name: [insert full name] Address:
DG CERTIFICATE & IMSBC CODE FITNESS CERTIFICATE Date of Classification Survey Application Date of Submission Same as above / Shipbuilder Same as applicant. Yard/Hull Number DG CERTIFICATE ※ For Japanese flag ships, NK conducts surveys only. Solid Dangerous Goods in Bulk Where loaded Cargo Hold No.: Other (Please specify): Class of Dangerous Goods (1)Please complete when restrictions apply to loading of specified cargo in order to meet relevant requirements. 4.1 4.2 4.3 5.1 6.1 8 9 Loading restrictions for Specified Cargo (1): Other Dangerous Goods Where loaded Weather Deck Cargo Hold No.: Other (Please specify): Class of Dangerous Goods (1)Please complete when restrictions apply to loading of specified cargo in order to meet relevant requirements. 1.1-1.6 1.4S 2.1 2.2 2.3( (flammable) (non-flammable)) 3 (all) 3 (liquid: flashpoint (C) below 23 between 23 and 60) 4.1 4.2 4.3( liquid solid) 5.1 5.2 6.1 (All) 6.1 (liquid: flashpoint (C) below 23 between 23 and 60 over 60 solid 8 (All) 8 (liquid: flashpoint (C) below 23 between 23 and 60 over 60 solid 9 Loading restrictions for Specified Cargo (1): IMSBC CODE FITNESS CERTIFICATE IMSBC Code Fitness Certificate Group A cargoes ( with / without restrictions on moisture content of cargoes) Group C cargoes Group B cargoes (Please list all cargoes. If insufficient space, please continue on a separate sheet.) Remarks: In cases where it is impossible to submit this form at the same time as the application form, please make sure to submit this form before the submission of any drawings for approval (including maker drawings).
Graduate School of Economics, Kyoto University AGST Overseas Challenge Programme 2018 Application Form Applicant Details Name Family name Given name(s) フリガナ In Japanese/Chinese characters if applicable: In Western alphabet (as shown on your passport): Country of Citizenship Affiliation ( ) year of Master’s / Doctoral course Student ID No.: Supervisor : Financial aid Are you currently getting financial support from any funding programme? No, I’m not getting any financial support. Yes, I’m getting a scholarship from ( ) Yes, I’m getting a grant funding from ( ) Current address 〒 Contact details PC e-mail: @ mobile e-mail: @ Phone: ( ) - Passport details Do you have a valid passport? Yes Applying /No (intend to apply by: ) Expiry date (year/month/day): Research Activities in the Destination Research period From: To: ( days) Destination city/country ※Do you need an entry visa? Yes No
(You may refer to pages 5 to 7 of the Applicant’s Guide, Research Program 2018-2019) SECTION IV : PROJECT’S COLLABORATIVE ASPECT (maximum 1500 characters) (Justify the role of every participant) SECTION V: ASSESSMENT OF THE PROJECT’S TRL AT STARTING POINT 1- AIMED FINAL APPLICATION (product – service – bioprocess)
L of NK Rules) End Link Grade 1 chain Common Link Enlarged Link End Link Flush butt welded Grade 2 chain Common Link Enlarged Link End Link Flush butt welded Casting Grade 3 chain Common Link Enlarged Link End Link Flush butt welded Casting Chains for offshore mooring (3.2, Chapter 3, Part L of NK Rules) Grade R3 offshore mooring chain With stud Studless Common Link Enlarged Link End Link Connecting common link Flush butt welded Grade R3S offshore mooring chain With stud Studless Common Link Enlarged Link End Link Connecting common link Grade R4 offshore mooring chain With stud Studless Common Link Enlarged Link End Link Connecting common link Grade R4S offshore mooring chain With stud Studless Common Link Enlarged Link End Link Connecting common link Grade R5 offshore mooring chain With stud Studless Common Link Enlarged Link End Link Connecting common link Others
Act, Sec.11 PAPUA NEW . Reg. Sec.5 Trade Marks Act (Chapter 385) Form 2 APPLICATION FOR AMENDMENT OR ALTERATION OF THE REGISTER UNDER SECTION 11 OF THE ACT PAYMENT BY BANK DRAFT OR CHEQUE ACCEPTED FEE: ITEM 5 FOR OFFICIAL USE (a) Here insert the full name of the individual, firm or body corporate making Application is hereby made by (a) application. If a body corporate, firm or analogous body is making application, indicate the State or country of incorporation or registration. The names of all parties in a firm must be given in full. (b) Here insert the full trade or business address whose trade or business address is (b) of the applicant: (c) Here insert the number of the Registered Trade Mark for amendment or alteration of the Register in respect of Registered Trade Mark No. (c) on the following grounds.
Building practitioner or architect engaged to prepare documents for this permit [List any building practitioner or architect engaged to prepare documents forming part of the application for this permit.] Name Category/class Registration no. Name Category/class Registration no. *Details of domestic building work insurance Name of builder Name of issuer or provider Policy number Policy cover $ *Details of relevant planning permit Planning permit no. Date of grant of planning permit Nature of building work Construction of a *new building/*extension/*alteration/*change of use/*demolition/*removal/*re-erection of a building *Storeys contained *Rise in storeys (for Class 2-9 building only) *Effective height *Type of construction Version of BCA applicable to permit Stage of building work permitted Cost of building work $ Total floor area of new building work in m2 Building classification Part of building BCA Classification Part of building BCA Classification *Performance solution A performance solution was used to determine compliance with the following performance requirements of the BCA that relate to the building to which this permit applies: Relevant performance requirement Details of performance solution [Insert details of performance solution(s) including applicable materials, systems, methods of building, procedures, specifications and other relevant requirements]
OPV1/Sabin1 and OPV3/Sabin3 IM will only be completed after the last use of bOPV and/or mOPV1/mOPV3. N° Facility name and address OPV1/Sabin1 or OPV3/Sabin3 IM 1. mOPV1 mOPV3 Sabin1 Sabin3 bOPV 2. mOPV1 mOPV3 Sabin1 Sabin3 bOPV 3. mOPV1 mOPV3 Sabin1 Sabin3 bOPV Please add rows as needed List of facilities retaining OPV/Sabin PIM Please ensure that complete data on the identification and retention of OPV2/Sabin2 PIM are provided within 1 year of the publication of the (i.e. by 10 April 2019). In countries that experienced VDPV2 circulation and the use of mOPV2 for outbreak response purposes after the switch from tOPV to bOPV, the collection of data on OPV2/Sabin2 PIM will only be completed after the last use of mOPV2. In countries that experienced the use of bOPV, and/or VDPV1/VDPV3 circulation and the use of mOPV1/mOPV3 for outbreak response purposes after the switch from tOPV to bOPV, the collection of data on OPV1/Sabin1 and/or OPV3/Sabin3 PIM will only be completed after the last use of bOPV, mOPV1 and/or mOPV3, respectively. N° Facility name and address OPV/Sabin PIM 1. OPV1/Sabin1 OPV2/Sabin2 OPV3/Sabin3 2. OPV1/Sabin1 OPV2/Sabin2 OPV3/Sabin3 3. OPV1/Sabin1 OPV2/Sabin2
(ICS 206) 1. Incident Name: 2. Operational Period: Date From: Date To: Time From: Time To: 3. Medical Aid Stations: Name Location Contact Number(s)/Frequency Paramedics on Site? Yes No Yes No Yes No Yes No Yes No Yes No 4. Transportation (indicate air or ground): Ambulance Service Location Contact Number(s)/Frequency Level of Service ALS BLS ALS BLS ALS BLS ALS BLS 5. Hospitals: Hospital Name Address, Latitude & Longitude if Helipad Contact Number(s)/ Frequency Travel Time Trauma Center Burn Center Helipad Air Ground Yes Level: Yes No Yes No Yes Level: Yes No Yes No Yes Level: Yes No Yes No Yes Level: Yes No Yes No Yes Level: Yes No Yes No 6. Special Medical Emergency Procedures: Check box if aviation assets are utilized for rescue. If assets are used, coordinate with Air Operations. 7. Prepared by (Medical Unit Leader): Name: Signature: 8. Approved by (Safety Officer): Name: Signature: ICS 206 IAP Page Date/Time:
9. Equipment Resources Kind Notes # Ordered # Available # Assigned # Out of Service USCG Assets Aircraft – Helo Aircraft – Fixed Wing Vessels – USCG Cutter Vessels – Boat Vehicles – Car Vehicles – Truck Pollution Equip – VOSS/SORS Pollution Equip – Portable Storage Pollution Equip – Boom Non-CG/Other Assets Aircraft – Helo Aircraft – Fixed Wing Vessels – SAR/LE Boat Vessels – Work/Crew Boat Vessels – Tug/Tow Boat Vessels – Pilot Boat Vessels – Deck Barge Vessels – Vehicles – Car Vehicles – Ambulance Vehicles – Truck Vehicles – Fire/Rescue/HAZMAT Vehicles – Vac/Tank Truck Vehicles – Pollution Equip – Skimmers Pollution Equip – Tank Vsl/ Barge Pollution Equip – Portable Storage Pollution Equip – OSRV Pollution Equip – Boom Pollution Equip – 10. Personnel Resources Agency Total # of People USCG DHS (other than USCG) NOAA FBI DOD (USN Supsalv, CST, etc.) DOI (US Fish & Wildlife, Nat Parks, BLM, etc.) RP State Local Total Personnel Resources Used From all Organizations:
(ICS 218) 1. Incident Name: 2. Incident Number: 3. Date/Time Prepared: Date: Time: 4. Vehicle/Equipment Category: 5. Vehicle/Equipment Information Order Request Number Incident ID No. Vehicle or Equipment Classification Vehicle or Equipment Make Category/ Kind/Type, Capacity, or Size Vehicle or Equipment Features Agency or Owner Operator Name or Contact Vehicle License or ID No. Incident Assignment Incident Start Date and Time Incident Release Date and Time
ST/Unit: LDW: # Pers: Order #: Agency Cat/Kind/Type Name/ID # Front Date/Time Checked-In: Pilot Name: Home Base: Departure Point: ETD: ETA: Destination Point: Date/Time Ordered: Manufacturer: Remarks: Prepared by: Date/Time: ICS 219-6 Fixed-Wing (Orange) ST/Unit: LDW: # Pers: Order #: Agency Cat/Kind/Type Name/ID # Back Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Prepared by: Date/Time: ICS 219-6 FIXED-WING (ORANGE)
ST/Unit: LDW: # Pers: Order #: Agency Cat/Kind/Type Name/ID # Front Date/Time Checked In: Leader Name: Primary Contact Information: Resource ID #(s) or Name(s): Home Base: Departure Point: ETD: ETA: Date/Time Ordered: Remarks: Prepared by: Date/Time: ICS 219-7 Equipment (Yellow) ST/Unit: LDW: # Pers: Order #: Agency Cat/Kind/Type Name/ID # Back Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Prepared by: Date/Time: ICS 219-7 Equipment (Yellow)
ST/Unit: LDW: # Pers: Order #: Agency Cat/Kind/Type Name/ID # Front Date/Time Checked In: Leader Name: Primary Contact Information: Resource ID #(s) or Name(s): Home Base: Departure Point: ETD: ETA: Date/Time Ordered: Remarks: Prepared by: Date/Time: ICS 219-10 GENERIC (LIGHT PURPLE) ST/Unit: LDW: # Pers: Order #: Agency Cat/Kind/Type Name/ID # Back Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Incident Location: Time: Status: Assigned O/S Rest O/S Pers Available O/S Mech ETR: Notes: Prepared by: Date/Time: ICS 219-10 GENERIC (LIGHT PURPLE)
2 3 4 5 9100 Series Clauses (A) = Not applicable for 9100 (B) = Not applicable for 9110 (C) = Not applicable for 9120 14Conformity 15NCR Number and Classification 1 2 3 4 5 6 7 8 9 10 11 12 4. Context of the Organization 4.1 Understanding the Organization and its Context 4.2 Understanding the Needs and Expectations of Interested Parties 4.3 Determining the Scope of the Quality Management System 4.4 Quality Management System and its Processes 4.4.1 4.4.2 16Summary of Objective Evidence: 5. Leadership 5.1 Leadership and Commitment 5.1.1 General 5.1.2 Customer Focus 9100 Series Clauses (A) = Not applicable for 9100 (B) = Not applicable for 9110 (C) = Not applicable for 9120 14Conformity 15NCR Number and Classification 1 2 3 4 5 6 7 8 9 10 11 12 5.2 Policy
7.2.3 Customer Communication 7.3 Design and Development * 7.3.1 Design and Development Planning * 7.3.2 Design and Development Inputs * 7.3.3 Design and Development Outputs * 7.3.4 Design and Development Review * 7.3.5 Design and Development Verification * 7.3.6 Design and Development Validation * 7.3.6.1 Design and Development Verification and Validation Testing * 7.3.6.2 Design and Development Verification and Validation Documentation * 7.3.7 Control of Design and Development Changes * 7.4 Purchasing 7.4.1 Purchasing Process 7.4.2 Purchasing Information 7.4.3 Verification of Purchased Product 7.5 Production and Service Provision Clauses (* = not applicable for 9120) 12 Conformity 13 NCR Number 1 2 3 4 5 6 7 8 9 10 11 12 7.5.1 Control of Production and Service Provision 7.5.1.1 Production Process Verification * (Maintenance Process Verification - 9110) 7.5.1.2 Control of Production Process Changes * (Control of Maintenance Process Changes - 9110) 7.5.1.3 Control of Production Equipment, Tools, and Software Programs * (Control of Maintenance Equipment,
Case ID Number: DEPRIVATION OF LIBERTY SAFEGUARDS FORM 3 AGE, MENTAL CAPACITY, NO REFUSALS, BEST INTERESTS ASSESSMENTS AND SELECTION OF REPRESENTATIVE This combined form contains 4 separate assessments and includes selection of representative. If any assessment is negative there is no need to complete the others unless specifically commissioned to do so by the Supervisory Body. Please indicate which assessments have been completed (*Supervisory Bodies will vary in practice as to who completes the Mental Capacity Assessment) Age Mental Capacity* No Refusals Best Interests This form is being completed in relation to a request for a standard authorisation This form is being completed in relation to a review of an existing standard authorisation under Part 8 of Schedule A1 to the Mental Capacity Act 2005. Full name of the person being assessed Date of birth (or estimated age if unknown) Est. Age This also constitutes the Age Assessment. If any uncertainty please provide additional information at the end of the form. Name and address of the care home or hospital in which the person is, or may become, deprived of liberty Name of the Assessor Address of the Assessor Profession of the Assessor Name of the Supervisory Body The present address of the person if different from the care home or hospital stated above. In carrying out this assessment I have met or consulted with the following people
Table 1 Kind/Welding process Kind Welding Process Electrodes for manual arc welding for mild steels, high tensile steels and steel for low temperature service (6.2, Chapter 6, Part M of NK Rules) Manual welding Gravity welding Automatic welding consumables for mild steels, high tensile steels and steel for low temperature service [Welding technique：Multi-run (M) Two-run (T) Multi-run and two-run (TM)] (6.3, Chapter 6, Part M of NK Rules) Submerged arc welding MAG welding MIG welding Self-shielded arc welding Semi-automatic welding consumables for mild steels, high tensile steels and steel for low temperature service (6.4, Chapter 6, Part M of NK Rules) MAG welding MIG welding Electro-slag and Electro-gas welding consumables (6.5, Chapter 6, Part M of NK Rules) Electro-slag welding Electro-gas welding One side automatic welding consumables for mild steels, high tensile steels and steel for low temperature service [Welding technique：One-run (SP) Multi-run (MP) One-run and multi-run (SMP)] (6.6, Chapter 6, Part M of NK Rules) Submerged arc welding MAG welding MIG welding Self-shielded arc welding Welding consumables for stainless steel (6.7, Chapter 6, Part M of NK Rules) Manual welding TIG welding (Wire Filler Rod) MIG welding ☐Semi-automatic welding ☐Submerged arc welding ☐Welding consumables for aluminum alloys (6.8, Chapter 6, Part M of NK Rules) ☐TIG welding (Wire Filler Rod) ☐MIG welding ☐Plasma arc welding ☐Welding consumables for quenched and tempered high tensile steels for structures (6.9, Chapter 6, Part M of NK Rules) Manual welding Gravity welding Submerged arc welding Automatic welding (MAG welding) Automatic welding (MIG welding) Self-shielded arc automatic welding Semi-automatic welding (MAG welding) Semi-automatic welding (MIG welding) ☐Others [Please clarify kind (including applicable parent material and its grades) and welding process] Table 2 Welding position/Max. diameter Butt Weld Fillet Weld Position Max. Diameter Position Max. Diameter Flat mm Flat mm Horizontal Vertical mm Horizontal mm Horizontal mm Overhead mm Horizontal Overhead mm Overhead mm Vertical Upward mm Vertical Upward mm Vertical Downward mm Vertical Downward mm
D: Peer Review: Observation of Teaching Report Dimensions of learning and teaching activity: Quantity and quality of evidence Students are actively engaged in learning Your examples and comments No apparent examples Some examples Many examples Extensive examples Effectiveness not clear Effective Very effective Exceptionally effective Students’ prior knowledge and experience is built upon Your examples and comments No apparent examples Some examples Many examples Extensive examples Effectiveness not clear Effective Very effective Exceptionally effective Teaching caters for student diversity Your examples and comments No apparent examples Some examples Many examples Extensive examples Effectiveness not clear Effective Very effective Exceptionally effective Students are encouraged to develop/expand their conceptual understanding Your examples and comments No apparent examples Some examples Many examples Extensive examples Effectiveness not clear Effective Very effective Exceptionally effective Students are made aware of key learning outcomes Your examples and comments No apparent examples Some examples Many examples Extensive examples Actively uses links between research or industry and teaching Your examples and comments No apparent examples Some examples Many examples Extensive examples Effectiveness not clear Effective Very effective Exceptionally effective Uses educational resources and techniques appropriately Your examples and comments No apparent examples Some examples Many examples Extensive examples Effectiveness not clear Effective Very effective Exceptionally effective Presents material logically Your examples and comments No apparent examples Some examples Many examples Extensive examples Effectiveness not clear Effective Very effective Exceptionally effective Seeks feedback on students’ understanding and acts on this accordingly No apparent examples Some examples Many examples Extensive examples
RECOMMENDATIONS AS TO CONDITIONS (Not applicable for review) Choose ONE option only I have no recommendations to make as to the conditions to which any Standard Authorisation should or should not be subject (proceed to the Any Other Relevant information section of this form). I recommend that any Standard Authorisation should be subject to the following conditions 1 2 3 4 RECOMMENDATIONS AS TO VARYING ANY CONDITIONS (Review only) Choose ONE option only The exisiting conditions are appropriate and should not be varied The existing conditions should be varied in the following way: 1 2 3 4 SHOULD ANY RECOMMENDED CONDITIONS NOT BE IMPOSED: I would like to be consulted again, since this may affect some of the other conclusions that I have reached in my assessment. I do not need to be consulted again, since I do not think that the other conclusions reached in this assessment will be affected. ANY OTHER RELEVANT INFORMATION Please use the space below to record any other relevant information, including any additional conditions that should or should not be imposed and any other interested persons consulted by you. RECOMMENDATIONS, ACTIONS AND / OR OBSERVATIONS FOR CARE MANAGER / SOCIAL WORKER / COMMISSIONER / HEALTH PROFESSIONAL
Bemidji State University Master of Science/Master of Arts Form 3 - Graduate Research Paper/Thesis Proposal A formal written proposal for a Graduate Research Paper or Thesis must be developed by each student seeking to complete a Master’s Degree at . Each student is responsible for: Initiating communication with the assigned advisor to ensure that the correct process for completing the proposal occurs. Acquiring the specific guidelines associated with the written proposal for a Graduate Research Paper or Thesis for the department or area of study. (Each Department may have requirements that differ from the University at large.) Becoming familiar with the guidelines that apply to the area of study and discuss questions related to the guidelines with his or her advisor. Acquiring the correct style manual (i.e. APA, MLA, etc.) for the Research Paper or Thesis as required by the department or field of study. Meeting with the advisor on a regular basis at mutually agreed upon times. Selecting on Oral Examination Committee (includes advisor). Presenting a draft of the Paper/Thesis on a regular basis to his or her advisor and committee members for comments and feedback. Obtain necessary form(s) from the Graduate Studies Office and provide copies of all required paperwork. Student: Print name Signature (not required if sent electronically) Current Address City State Zip code Email Address Phone BSU Student ID#: Date: Proposed Title/Topic: The signatures affixed to this page, in the spaces provided below, indicate that the proposal (noted above) has been read and approved as an appropriate activity for additional research and study. Advisor (Committee Chair) Print name Date Committee Member Print name Date Committee Member: Print name Date College Dean Date Please return this completed form AND proposal to the Graduate Studies Office, Deputy Hall 111 7/25/2014
Year Term PLEASE ENSURE ALL PAGES ARE COMPLETED AND SIGNED APPLICANT DETAILS RESIDENTIAL STREET ADDRESS Unit # Street # Address Town/Suburb State Postcode Exact distance (in km) by the shortest practicable route From home to school km From home to bus stop km PARENT/GUARDIAN DETAILS First Name Surname Telephone First Name Surname Telephone Email TRAVELLER DETAILS Student one First Name Surname Date of birth Travel start date School enrolled Year level VSN FTE (must be 3 days or more attendance): Student claiming (please use X to highlight) To/from school To/From School and off campus Single mode (One mode of transport only) Multi mode* Must be 4.8km or more to Bus Stop Student two First Name Surname Date of birth Travel start date School enrolled Year level VSN FTE (must be 3 days or more attendance): Student claiming (please use X to highlight) To/from school To/From School and off campus Single mode (One mode of transport only) Multi mode* Must be 4.8km or more to Bus Stop Student three First Name Surname Date of birth Travel start date School enrolled Year level VSN FTE (must be 3 days or more attendance): Student claiming (please use X to highlight) To/from school To/From School and off campus Single mode (One mode of transport only) Multi mode* Must be 4.8km or more to Bus Stop Note: An eligible student may be granted an allowance based on the least expensive public transport fares only. A copy of your ticket/fare purchase should be attached to this form e.g. Victorian Student Pass, Transit Student Pass. If there are more than three students claiming from this home residence, please complete another Form 3 and attach together. *Multi mode provision does not apply if the journey could have been undertaken using a single mode transport or one leg of the journey is less than 4.8km. If multi mode includes private travel, complete Form 1 (private car) or Form 2 (private bus) to accompany this public travel application.
1. Document Approvals I have reviewed this SWTM for conformance to traceability requirements and approve it for the subject software. 1.1. Name (last, first) 1.2. Z No. 1.3. Role 1.4. Signature and Date SO SO RLM Other 2. SWTM Revision History 2.1. Revision 2.2. Date 2.3. SWTM Revision Description and Reason 3. General 3.1. Introduction The purpose of this SWTM is to aid in satisfying applicable software traceability requirements as required by the subject software project planning document, (Sample text: Enter software project planning document number and title here). 4. Matrix 4.1 Test Plan(s) 4.2 Requirement Source 4.3 Software Requirement (No. and Topic) 4.4 Design Location 4.5 Code Location 4.6 Test Case No. Sample text: , App. G, NNSA SD 1027, Change Notice 1 R 1.2 Hazard category radionuclide threshold quantities Software Design Document (SDD) 201, § 4.2.2 Read_Blk_TQs Ver_Blk_TQ STC TQ011; STC TQ012; STC TQ013
VERIFICATION GEORGIA, BIBB COUNTY Personally appeared before me the undersigned Petitioner(s) who, after being duly sworn, state(s) that the facts set forth in the foregoing petition (and the attached exhibits) are true. Sworn to and subscribed before me this ______ day of ________________, 20____. ____________________________________ Signature of First Petitioner ___________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name of First Petitioner My Commission Expires _______________ Sworn to and subscribed before me this ______ day of _________________, 20___. ____________________________________ Signature of Second Petitioner ___________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name of Second Petitioner My Commission Expires _______________
Shipbuilder Yard/Hull Number MAIN PARTICULARS OF CARGO GEAR CARGO GEAR (DERRICK/CRANE) Location and description with distinguishing number or mark, if any Intended safe working load (tons) - allowable minimum angle (degrees) or allowable maximum radius (meters) Load Angle/Radius Dual Load Angle/Radius UNION PURCHASE ※Please also complete the separate Form 3A-4-2. Location and description with distinguishing number or mark, if any Intended safe working load (tons) - allowable minimum angle (degrees) or allowable maximum radius (meters) Safe working load Maximum fall angle Swing system Load Angle/Radius RAMPS/LIFT FOR CARGO Location with distinguishing number or mark, if any Intended safe working load (tons) Remarks
2. _____ (Name)_________________ Signatures _________________________ (Designation) Date _________________________________.