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[null,null,"労務管理に関する自主点検結果報告書"]
[null,"事業場の名称",null,null,null,null,null,"代表者職氏名"]
[]
[]
[null,null,null,null,null,null,null,"労働者数\n（内パート数）","　　　　　　　　　人　\n　（内　　　　　　人）　　　　"]
[]
[null,"所在地"]
[]
[null,null,null,null,null,null,null,"企業規模\n（全労働者数）","　　　　　　　　　人　"]
[]
[null,null,null,"TEL　　　(　　　)"]
[null,"本社所在地",null,null,null,null,null,"資本金","　　　　　　　　円"]
[]
[]
[null,"業種",null,null,null,null,null,"点検者職氏名"]
[]
[]
[]
[null,"　自主点検の結果について、別添の「労務管理に関する自主点検表」の該当番号等を下表の「点検の結果」欄の同じ番号に〇を記載し、表面・裏面ともにFAX等により報告してください。\n　なお、本個表を行政目的以外で使用することはありません。"]
[]
[]
[]
[null,"点検項目",null,null,null,null,"点検の結果"]
[]
[null,"１　労働条件の明示",null,null,null,null,"１・２・３・４"]
[]
[null,"２　有期労働契約",null,null,null,null,"１・２・３・４"]
[]
[null,"３　就業規則",null,null,null,null,"１・２・３・４・５"]
[]
[null,"４　就業規則・時間外労働協定などの周知",null,null,null,null,"１・２・３・４"]
[]
[null,"５　所定労働時間",null,"ア　労働者10人未満の商業・接客娯楽業等の事業場",null,null,"１・２・３"]
[]
[null,null,null,"イ　上記ア以外の事業場",null,null,"１・２・３"]
[]
[null,"６　変形労働時間制",null,null,null,null,"１・２・３・４"]
[]
[null,"７　時間外・休日労働に関する協定",null,null,null,null,"１・２・３・４"]
[]
[null,"８　所定休日",null,null,null,null,"１・２・３・４・５・６・７"]
[]
[null,"９　年次有給休暇",null,"（１）付与日数",null,null,"１・２・３"]
[]
[null,null,null,"（２）計画年休",null,null,"１・２"]
[]
[null,null,null,"（３）時間単位年休",null,null,"１・２"]
[]
[null,"９　年次有給休暇",null,"（４）特別休暇",null,null,"１・２"]
[]
[null,null,null,"（５）労使協定",null,null,"１・２"]
[]
[null,null,null,"（６）年5日の年次有給休暇\n　　の確実な取得の対象",null,null,"１・２"]
[]
[null,null,null,"（７）年5日の取得",null,null,"１・２"]
[]
[null,null,null,"（８）付与6か月経過時点の\n　　年次有給休暇未取得",null,null,"１・２"]
[]
[null,null,null,"（９）年5日を自ら取得",null,null,"１・２"]
[]
[null,null,null,"（10）計画年休による付与",null,null,"１・２"]
[]
[null,null,null,"（11）管理簿",null,null,"１・２・３"]
[]
[null,"10　休業",null,"（１）休業の有無",null,null,"１・２"]
[]
[null,null,null,"（２）休業手当の有無",null,null,"１・２"]
[]
[null,"11　賃金控除",null,null,null,null,"１・２・３・４"]
[]
[null,"12　最低賃金",null,"（１）支払",null,null,"１・２"]
[]
[null,null,null,"（２）最も賃金の低い者の額",null,null,"1時間当たり　　　　　　　　　　　円"]
[]
[null,"13　割増賃金",null,"（１）時間外労働・深夜労働",null,null,"１・２・３・４・５・６"]
[]
[null,null,null,"（２）休日労働",null,null,"１・２・３・４・５・６"]
[]
[null,"14　解雇",null,null,null,null,"１・２・３・４"]
[]
[null,"15　健康診断",null,null,null,null,"１・２・３"]