ࡱ> i M$bjbj {b{b4h.Lzl%24R%T%T%T%T%T%T%$')x%x%%[[[R%[R%[[$@B$/$>%%0%$*B*,$*$X[x%x%[%*B X: Please retain this form within the department/section when completed. This assessment must be carried out by the relevant Department/Section Head (or their nominee). This checklist will help identify hazards and enable subsequent Risk Assessments to be completed where hazards cannot be eliminated. [See Section 19.1 - 19.5]. See also SECTION 18.2.0 FIRE & other Emergencies in Document 2 for requirements Room/Location: ______________________ Employee Involved: ________________________________ Assessed By: _____________________________________________________ Date: _________________ 1.0TRAINING AND INFORMATIONYESNON/ARECOMMENDATIONS/ACTIONS1.1Are all staff and students familiar with what to do in an emergency e.g. Fire, explosion, gas leak, lift failure etc.?1.2Have all staff been trained in basic fire safety:- housekeeping use of flammable liquids, gases or solids electrical appliances fire extinguisher selection and use what to do on hearing fire alarm what to do on discovering fire what to do if ones clothing is on fire1.3Do they know where the fire alarm is, and how to use it?1.4Are there trained Fire Marshalls/First Aid Responders and trained Chemical Spill Responders ( where relevant) in the Department, with nominated deputies or is there pre-agreed cover from adjacent areas? 2.0EMERGENCY PROCEDURESYESNON/ARECOMMENDATIONS/ACTIONS2.1Is there an appropriate department emergency plan in operation and does this include for major events organised by the School/Department?2.2Does it cover the following: Fire drills and training Safe evacuating procedures to assembly or refuge points including Personal Emergency Evacuation Plans for impaired persons and evacuation triage and sheltering in place where relevant and non-use of lifts Designated assembly points and control of personnel until the all clear is given by Security/the Fire Brigade Emergency numbers and whom to contact Premises Eircodes Emergency lighting Clearly sign posted exit routes, fire fighting equipment and first aid equipment and chemical spill response equipment ( where relevant) Response outside normal working hours Provisions for persons with impaired vision, hearing or mobility Ensuring that equipment, machines are shut off to leave workplace safe Chemical spills Warning personnel in adjacent areas of potential hazards to their safety Hazard and risk information for the fire services including chemical inventories and key risks . 2.3Is the Emergency Plan tested regularly Yearly? 2.4During the emergency test, are shortcomings: Recorded by the Department? Reviewed and corrected? 3.0GENERALYESNON/ARECOMMENDATIONS/ACTIONS3.1Are the "No-Smoking" Regulations strictly enforced?3.2Are fire doors kept closed outside normal working hours?3.3Is portable fire fighting equipment, firest aid kits and chemical spill response kits available and maintained?3.4Are escape routes, corridors etc. kept clear at all times of storage, furnishings, combustible materials, rubbish, recycling materials, bicycles, motorized apparatus and sources of ignition including electrical equipment ?3.5Are escape routes of adequate width and number?3.6Are combustible or other wastes removed daily? 3.7Are there routine checks carried out on: Fire alarm systems? Emergency lighting and exits? Fire fighting equipment? Emergency equipment? Safety signs? First Aid boxes? 3.8Are these recorded and reviewed by the Department?3.9Are Fire notices posted in prominent positions throughout the Department?3.10Are there sufficient smoke/heat fire detection units audible alarm bells and measures for the hearing impaired?3.11Are there sufficient fire alarm break glass units?3.12Is fire-fighting equipment clearly sign posted?3.13Can the emergency exit doors be easily and quickly opened? 3.14Is a fire blanket available and accessible in kitchens/canteens?3.15Is the external fire assembly point signposted and visible?3.16Are all doors on escape routes easily openable from the inside without the use of a key and in the case of electromagnetic locks openable on mechanical activation of a door lock lever arm or push bar device?3.17Are metal bins with self closing lids used for rubbish collection within corridors, laboratories, work shops, lecture theatres and large rooms? 4.0LABORATORIES / workshops (in addition to above)4.1Is there a central location for storage of emergency equipment viz. Self contained breathing apparatus? Salvage gear, tools, lamps, chemical spill response equipment? blankets for covering injured persons Stretchers? First aid for unusual situations e.g. cyanide exposure, hydrofluoric acid?4.2Is PPE available for emergencies (goggles, facemasks, aprons, respirators, explosion shields, etc.)?4.3Is there an emergency phone in the lift and can this communicate with UCC security 4.4Does the chemical spill procedures include: Containment controls? Clean-up measures? Reporting provisions? Prevention methods i.e. personnel training, inspection, monitoring, storage. 4.5Is all hazardous laboratory work stopped during severe weather or loss of utility services e.g. water, electricity, gas supplies etc.?4.6Are the fire extinguishers appropriate to the various risks within the laboratory/workshop?4.7Is an appropriate chemical spill kit provided in the laboratory or nearby?4.8Is there a gas detection system with slam shut devices to the supply fitted for all gas supplies to the room/area?4.9Is there a gas proving system fitted to the natural gas supply where provided?4.10Is hydrogen generation technology used instead of piped gas cylinder supply?4.11Are all compressed gas cylinders located external to the building and the supply piped in to the point of use incorporating 4.94.12Is an easily accessible emergency power off switch provided and located conveniently to shut down the electrical supply in an emergency?4.13 4.14Are flammable liquids stored in bunded fire rated cabinets within the room? Do first aid responders have a personal issue emergency response kit for Covid19 and is there one located adjacent to the first aid box/boxes with spares available ( for replacement after use) Please retain this form within the department/section when completed. This assessment must be carried out by the relevant Department/Section Head (or their nominee). This checklist will help identify hazards and enable subsequent Risk Assessments to be completed where hazards cannot be eliminated. [See Section 19.1 - 19.5]. See also SECTION 18.2.0 FIRE & other Emergencies in Document 2 for requirements     DEPARTMENT SAFETY STATEMENT DOCUMENT NO.3: Hazard Identification and Risk Assessment SECTION 19.3.5 - Fire and other Emergencies check list Rev.4 Date: Jan 2022 PAGE  PAGE 3 of  NUMPAGES 3 Hum\Doc3\Sect19.3-5 DOCUMENT NO.3: Hazard Identification and Risk Assessment SECTION 19.3.5 - Fire and other Emergencies check list (Cont.) Rev.1 Date: May 98 0 < F G O x N P Q T U m n q r t u x y    & * + / h l m q ƻ򱤚Ʊ򱻎vh(p@CJOJQJh0]@CJOJQJhY@CJOJQJh1CJOJQJh15@CJOJQJh1CJOJQJh15CJOJQJh1h1@CJOJQJh156@CJOJQJhE5@CJOJQJh15@CJOJQJ*FF O t$ # 0p@ P 6$*$If^ ` 0$*$If 0p@  $*$If^` 0Z$*$If  *$ & F  *$$ & F 0*$a$ $ & F 0*$a$ O P Q U n r u y $If $$Ifa$$If2kd$$IfxQ'Q'4 xax     mgg^^^g $$Ifa$$Ifkd]$$Iflֈb&]P'77 4 lal   I W mg[L= & F 0$*$If & F 0$*$If 0$*$If$Ifkd$$Iflֈb&]P'77 4 lal & ' ( ) * $If $$Ifa$ & F$If & F$If & F 0$*$If & F 0$*$If & F 0$*$If * + / h i j k l mg[RRRg $$Ifa$ 0$*$If$Ifkd$$Iflֈb&]P'77 4 lall m q < = > ? @ mg[RRRg $$Ifa$ 0$*$If$Ifkd$$Iflֈb&]P'77 4 lal : ; < @ A E F Z [ ^ _ a b e f ~    R|xi]]h'9@CJOJQJh15>*@CJOJQJhY@CJOJQJh1h1CJOJQJh15@CJOJQJh15CJOJQJh1CJOJQJh15@CJOJQJh1@CJOJQJh0]@CJOJQJ%hr'&hY@B*CJOJQJph%hr'&h0]@B*CJOJQJph!@ A B F [ _ b f ~ mkee\\\V$If $$Ifa$$Ifkd$$Iflֈb&]P'77 4 lal~  hbVMMMb $$Ifa$ 0$*$If$Ifkd$$Iflֈb&]Q'77 l4 laytY3LhbVGGGGG & F 0$*$If 0$*$If$Ifkd$$Iflֈb&]Q'77 l4 laytYMNZec  rvwxy}~вХܥܥxnxhYCJOJQJhY5@CJOJQJhY5CJOJQJh15CJOJQJh1CJOJQJh15@CJOJQJhYhY@CJOJQJhYh1@CJOJQJhY@CJOJQJh1@CJOJQJh'9@CJOJQJh(p@CJOJQJ&[ c$If $$Ifa$ & F 0$*$IfgdY & F 0$*$Ifgdr'& & F 0$*$If    hbSJJJb $$Ifa$ 0$*$IfgdY$Ifkd$$Iflֈb&]Q'77 l4 laytY  =YrsthbVGG>> $$Ifa$ & F 0$*$If 0$*$If$Ifkd$$Iflֈb&]Q'77 l4 laytYtuvwxyz{|YM 0$*$Ifkd$$Iflֈb&]Q'77 l4 laytY$If $$Ifa$|}~bYJ>>> $$Ifa$gdr'& 0$*$Ifgdr'& $Ifgdr'&kd$$Iflֈb&]Q'77 l4 laytY$If(,-15?CDI04;ͱͥͱ͒ͱͱͱͱͱͱ͒ͱͱͱ%hr'&hY@B*CJOJQJphh(p@CJOJQJhY5@CJOJQJhY5>*@CJOJQJhY@CJOJQJhY5CJOJQJhYCJOJQJhYhY5@CJOJQJ95, $Ifgdr'&kd $$Iflֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $Ifgdr'& $$Ifa$gdr'& 0$*$Ifgdr'&(>5& 0$*$Ifgdr'& $Ifgdr'&kd $$Iflֈ7b&]Q'+7v~ 04 laytY()*+, $Ifgdr'& $$Ifa$gdr'&,-1>5& 0$*$Ifgdr'& $Ifgdr'&kd $$Iflֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&>5& 0$*$Ifgdr'& $Ifgdr'&kd $$Iflֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&>5& 0$*$Ifgdr'& $Ifgdr'&kd $$Iflֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&>5& 0$*$Ifgdr'& $Ifgdr'&kd$$Iflֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&.<3$ 0$*$Ifgdr'& $Ifgdr'&kd'$$Ifl\ֈ7b&]Q'+7v~ 04 laytY.B`y $Ifgdr'& $$Ifa$gdr'& & F 0$*$Ifgdr'& & F 0$*$Ifgdr'& >5& 0$*$Ifgdr'& $Ifgdr'&kd?$$Iflֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&?>5& 0$*$Ifgdr'& $Ifgdr'&kdS$$Iflֈ7b&]Q'+7v~ 04 laytY?@ABC $Ifgdr'& $$Ifa$gdr'&CDI>5& 0$*$Ifgdr'& $Ifgdr'&kdg$$Iflֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&<3$ 0$*$Ifgdr'& $Ifgdr'&kd{$$Ifl0ֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&0<3$ 0$*$Ifgdr'& $Ifgdr'&kd$$Ifl&ֈ7b&]Q'+7v~ 04 laytY01234 $Ifgdr'& $$Ifa$gdr'&45:v<3$ 0$*$Ifgdr'& $Ifgdr'&kd$$Iflֈ7b&]Q'+7v~ 04 laytY45:vz{  {SWX[\}s}s}shh'95CJOJQJhaCJOJQJha@CJOJQJha5@CJOJQJha5CJOJQJh15CJOJQJ$hr'&hY5B*CJOJQJph%hr'&hY@B*CJOJQJphhY5@CJOJQJhY@CJOJQJhY5CJOJQJhYCJOJQJ%vwxyz $Ifgdr'& $$Ifa$gdr'&z{>5& 0$*$Ifgdr'& $Ifgdr'&kd$$Iflֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&<3$ 0$*$Ifgdr'& $Ifgdr'&kd$$Ifl|ֈ7b&]Q'+7v~ 04 laytY    $Ifgdr'& $$Ifa$gdr'&  <3$ 0$*$Ifgdr'& $Ifgdr'&kd$$Ifl|ֈ7b&]Q'+7v~ 04 laytY $Ifgdr'& $$Ifa$gdr'&{<3$ 0$*$Ifgdr'& $Ifgdr'&kd$$Ifl|ֈ7b&]Q'+7v~ 04 laytY{|}~ $Ifgdr'& $$Ifa$gdr'&<::5gdakd$$Ifl|ֈ7b&]Q'+7v~ 04 laytY $$Ifa$gdu 0$*$Ifgdu $IfgduC:+ 0$*$Ifgdu $Ifgdukd7$$Iflֈ7b]'+pv 04 laytu)h $Ifgdu $$Ifa$gdu & F 0>$*$If^>`gdu & F 0>$*$If^>`gdu SC:+ 0$*$Ifgdu $Ifgdukd$$Iflֈ7b]'+pv 04 laytuSTUVWX.kd$$Iflֈ7b]'+pv 04 laytu $Ifgdu $$Ifa$gduX\ $$Ifa$gdu 0$*$Ifgdu $Ifgdu\y}~  nrsu۹ѬїmZG%hr'&hY@B*CJOJQJph%hr'&ha@B*CJOJQJph(hr'&ha5@B*CJOJQJph(hr'&h'95@B*CJOJQJph(hr'&hY5@B*CJOJQJphhY5@CJOJQJh'95@CJOJQJha5CJOJQJhaCJOJQJha5@CJOJQJha@CJOJQJh'9@CJOJQJC:+ 0$*$Ifgdu $Ifgdukd $$Iflֈ7b]'+pv 04 laytu.kd!$$Iflֈ7b]'+pv 04 laytu $Ifgdu $$Ifa$gdu+yz{|} $Ifgdu $$Ifa$gdu & F 0$*$Ifgdu & F 0$*$Ifgdu 0$*$Ifgdu $Ifgd'9 }~ C:+ 0$*$Ifgdu $Ifgdukd #$$Iflֈ7b]'+pv 04 laytu     .kd$$$Iflֈ7b]'+pv 04 layta $Ifgdu $$Ifa$gdunopqr $$Ifa$gdu 0$*$Ifgdu $IfgdurswC:+ 0$*$Ifgdu $Ifgdukd3%$$Iflֈ7b]'+pv 04 laytauv>BCEFw{|       e f &!'!+!,!ٯ쯢쯢쯢xexe%hr'&h(p@B*CJOJQJphh(p@B*CJOJQJphhu@B*CJOJQJphhuCJOJQJhu5@CJOJQJ%hr'&hu@B*CJOJQJphhaCJOJQJha5@CJOJQJ%hr'&ha@B*CJOJQJph%hr'&h'9@B*CJOJQJph&.kdG&$$Iflֈ7b]'+pv 04 layta $Ifgdu $$Ifa$gdu>?@AB $Ifgdu $$Ifa$gdu 0$*$Ifgdu $Ifgd'9BCGC:+ 0$*$Ifgdu $Ifgd'9kd['$$Iflֈ7b]'+pv 04 layta.kdo($$Iflֈ7b]'+pv 04 laytu $Ifgdu $$Ifa$gdu $$Ifa$gdu 0$*$Ifgdu $IfgduwC:+ 0$*$Ifgdu $Ifgdukd)$$Iflֈ7b]'+pv 04 laytuwxyz{|.kd*$$Iflֈ7b]'+pv 04 laytu $Ifgdu $$Ifa$gdu|  $$Ifa$gdu 0$*$Ifgdu $Ifgdu     C::: $Ifgdukd+$$Iflֈ7b]'+pv 04 laytu f '!(!)!*!+! $Ifgdu $$Ifa$gdu 0$*$Ifgdu+!,!-!.!t!C>4& $ & F 0*$a$ $ 0*$a$gdakd,$$Iflֈ7b]'+pv 04 laytu,!-!u"v"~""""""""""""J#y#z#{#|#########Ƚo\%h(p0JCJOJQJaJmHnHu hEh10JCJOJQJaJ)jhEh10JCJOJQJUaJ h10Jjh10JUh1h15OJQJhY5@OJQJh15@OJQJhVfjhVfUha@CJOJQJha56@CJOJQJha5@CJOJQJhat!!u"""""""""""(#,$ 0$d%d&d'd*$NOPQa$,$  $d%d&d'd*$NOPQa$gdcx & F  *$$ & F 0*$a$ (#z#{########},$  $d%d&d'd*$NOPQa$ $dN$G&`#$+Da$&`#$/$ &$d%d&d'd*$NOPQa$gdE ############I$J$K$L$M$ʵصxnj_VRNBha@CJOJQJhVfhaha5OJQJha5@OJQJh1h1CJOJQJ hEh10JCJOJQJaJ,jhEhE0JCJOJQJUaJ*(h(p0JCJOJQJaJmHnHu*)jhEhE0JCJOJQJUaJhE0JCJOJQJaJ hEhE0JCJOJQJaJ,jhEh10JCJOJQJUaJ*#J$K$L$M$ & F  *$/$ &$d%d&d'd*$NOPQa$gdu+0. A!"#$%S 4 00:pa. A!"#$%5 1 0:pa. A!"#$%S [$$Ifx!vh#vQ':V x5Q'/ 44 xax$$Ifl!vh#v#v#v#v7#v :V l555575 / 4al$$Ifl!vh#v#v#v#v7#v :V l555575 /  / /  / /  / / 4al$$Ifl!vh#v#v#v#v7#v :V l555575 /  / /  / /  / / 4al$$Ifl!vh#v#v#v#v7#v :V l555575 /  / /  / /  / / 4al$$Ifl!vh#v#v#v#v7#v :V l555575 / / / / / / / / /  4al$$Ifl!vh#v#v#v#v7#v :V ll555575 / 4ytY$$Ifl!vh#v#v#v#v7#v :V ll555575 /  / /  / /  / / 4ytY$$Ifl!vh#v#v#v#v7#v :V ll555575 /  / /  / /  / / 4ytY$$Ifl!vh#v#v#v#v7#v :V ll555575 /  / /  / /  / / 4ytY$$Ifl!vh#v#v#v#v7#v :V ll555575 /  / /  / /  / / 4ytY$$Ifl!vh#v#v#v#v7#v :V ll555575 / / / / / / / / /  4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / / / / / 4ytY<$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  / /  /  / /  / / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l\055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l0055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l&055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l|055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l|055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l|055+5575v5~ / /  /  /  /  / 4ytY$$If!vh#v#v+#v#v7#vv#v~ :V l|055+5575v5~ / /  /  /  /  / 4ytYX$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 /  /  / / / /  / / / / / 4ytu<$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  / /  /  / /  / / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4yta$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4yta$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4yta$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4yta$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 / /  /  /  /  / 4ytu$$If!vh#v#v+#v#vp#vv#v :V l055+55p5v5 /  /  / /  / / 4ytus6866666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p(8HX`~8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH L`L Normal$@CJOJQJ_HaJmH sH tH N@N  Heading 1$@&5@CJOJQJ\aJDA`D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List 44 Header  9r 4 @4 Footer  9r .)@. Page NumberPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< M-c  4\u,!#M$%?PXdgO  * l @ ~  t|(,.?C04vz {SX} rBw|  +!t!(##M$ !"#$&'()*+,-./0123456789:;<=>@ABCDEFGHIJKLMNOQRSTUVWYZ[\]^_`abcefh!!8@0(  B S  ?= J V \ ` m  MW:@KNF = X  :s ()g*wKt(4^kKN333333333333333333333333333q|T uvEFe&ijqy{N4 ct `6Q4 zzbsFU#[I^Tr=|r~eftf*@^`)@^`)@q^`()@^`)@q^`()@^`()@^`()|r~e|r~e|r~e|r~e|r~e|r~e|r~esFUctt4`6Q4`6Q4`6Q4`6Q4`6Q4I^I^I^I^ S@ ^`OJQJo( e< @^`() @^`()( z0@^`()L0@^`()О0@q^`()`ese@q^`()@q^`() @q^`()Х @q^`()p @q^`() @q^`()X @q^`() @q^`()15 r'&'9>H`Vf(p %rcxa0]YuuE@ M@UnknownG.[x Times New Roman5Symbol3. .[x Arial9GaramondA$BCambria Math"1h+g+gz,F 0 0!4JQHP ?E2!xxA ,F Please retain this form within the department/section when completed A. C. Patrick John Ring,        Oh+'0 ( <H h t  H Please retain this form within the department/section when completedA. C. PatrickNormal John Ring3Microsoft Office Word@@J(@$.@T/ ՜.+,04 hp  U.C.C.0  G Please retain this form within the department/section when completed Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghiklmnopqrstuvwxyz{|}~Root Entry FPK)/Data j-1Table*WordDocumentSummaryInformation(DocumentSummaryInformation8CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q