ࡱ> ?A>5@C.bjbj22!0XX2 VVVVVVVj    $2 <jz F|@$RQVVVDVV"VV-n ' IZ0%2F-jjVVVVV-jj  x jj  LKARINTYG fr arbete med joniserande strlning Intyg enligt Statens strlskyddsinstituts freskrifter SSI FS 1998:6 (DOCTORS CERTIFICATE For work with ionising radiation Cerificate according to the Regulations (SSI FS 1998:6) of the Swedish Radiation Protection Institute) Fylls i och undertecknas av arbetstagaren samt lmnas till lkaren (To be filled in and signed by the employee and handeld over to the doctor) Personnummer  FORMTEXT       Security-number Namn  FORMTEXT       Name Adress  FORMTEXT       Address Postnr, postadr  FORMTEXT       Telefon  FORMTEXT       Telephone  Detta intyg grundar sig p en genomfrd lkarunderskning  FORMCHECKBOX  (The basis for this certificate is a medical examination) Detta intyg grundar sig p periodisk kontroll  FORMCHECKBOX  (The basis for this certificate is a health review)  Vid underskningen har inte framkommit ngot som utgr hinder fr arbetet med joniserande strlning. Den underskte bedms tjnstbar. (At the medical examination/health review nothing that would prevent work with ionising radiation has been found. The examined person is regarded as fit)  FORMCHECKBOX  sign  Vid underskningen har inte framkommit ngot som utgr hinder fr arbetet med joniserande strlning under frutsttning att: (At the medical examination/health review nothing that would prevent work with ionising radiation has been found provided that:)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMCHECKBOX  & & & & & & sign  Den underskte personen bedms icke tjnstbar i arbete med joniserande strlning (The examined person is regarded as unfit for work with ionising radiation)  FORMCHECKBOX  sign  Datum, underskrift och stmpel (Date, signature and stamp)  FORMTEXT  DATE \@ "yyyy-MM-dd" 2003-10-092003-10-09 ..  Den underskte har enligt 12 Statens strlskyddsinstituts freskrifter (SSI FS 1998:6) rtt att begra prvning om det skulle finnas hinder mot arbete med joniserande strlning. Prvning begrs skriftligen vid Statens strlskyddsinstitut, 171 16 Stockholm. Sklet till att prvningen begrs skall bifogas. The ex 1vw   Y  . X Z n p r | ~   $ & ( 2 4 ʴʩʼʴʐʼʴʅ~sj\haU ha6CJjhaUjthaUjhaUmHnHujhaUjhaUhaha6CJmH sH hahamH sH haha6CJmH sH haha6mH sH  haCJ ha5CJha- 1hvw  Y  . 0 6 8 $If$If$IfC.4 b d x z |     Y [ [  !"uo haCJjLhaUhahaCJ mH sH hahaCJmH sH jShaUhahamH sH haha6CJmH sH jhaU haCJ ha6 ha6CJjhaUmHnHujhaUjhaUha+ Z [   $IflkdD$$IfF0%504 Fa$If  [  wwg ]9!$If  f]9!$If^ ]9!$If$IfYkd$$IfF%H%04 Fa !"d !8:bd ]u!$If ]9!$If$IfYkd$$IfF%H%04 Fa" !",-  &(*46:<PRT^`dfz|~r ).23RjhaU haCJ haCJ jhaUjhaUj-haUjhaUjhaUmHnHujEhaUjhaUhahamH sH haha6CJmH sH ha2r)1m  f]9!$If^Ykd$$IfF%H%04 Fa$If  f]9!$If^ 123nopq$If$IfYkd$$IfF%H%04 FaRmqr|},,+-..A.C.͹ͮ jhaCJUhaha6CJmH sH  haCJ haCJ ha5j haUhamHnHujhaUha ha6CJ+-B.C.Ykd $$IfF%H%04 Faamined person has according to 12 in the Regulations (SSI FS 1998:6) the rigth to appeal if something that would prevent work with ionising radiation is considerd. This is done in writing to the Swedish Radiation Protection Institute, 171 16 Stockholm. The reason for the appeal shall be enclosed) ___________________________________________________________________________________________________________________________________________ Blanketten enligt Statens Strlskyddsinsituts freskrifter SSI FS 1998:6 ( 2003 min-dokotr.com upprttad 2003-07-30 Reviderad 2003-07-30 0/ =!"#$%tDText1tDText2tDText3tDText4tDText5$$If!vh555#v5#v:V F055544 FtDeKryss1tDeKryss2$$If!vh5H%#vH%:V F05H%44 FtDeKryss3$$If!vh5H%#vH%:V F05H%44 FtDText6tDText7tDText8tDText9tDeKryss4$$If!vh5H%#vH%:V F05H%44 FtDeKryss5$$If!vh5H%#vH%:V F05H%44 FDText10 yyyy-MM-dd$$If!vh5H%#vH%:V F05H%44 F@@@ NormalOJQJ_HmHsHtH:@: Rubrik 1$@&5CJ6@6 Rubrik 2$@&5:@: Rubrik 3$@&6CJJAJ StandardstycketeckensnittXi@X  Normal tabell :V 44 la 0k@0 Ingen lista 2O2 Formatmall10B@0 BrdtextCJ2 0 1hvwY/78\]_k%`   !6P^_`a !"]^_` 1 4 0x0x0x0x0x0x0x0x0x0x0x0x0x 0x0x0x0x0x0x0x0x0x0x0x0x0x0x0x0x 0| 0x0x0x0x0x0x0x 0| 0x0x0x0x0x0x0x0x0x 0| 0x0x0x0x0x0x0x0x0x0x0x0x0x0x0x0x 0| 0x0x0x0x0x0x 0| 0x0x0x0x0x0x0x 0| 000004 "RC.  1C. C. '-HTZr~L\  !-36F`k2 FFFFFG G G FFFFG G FText1Text2Text3Text4Text5Kryss1Kryss2Kryss3Text6Text7Text8Text9Kryss4Kryss5Text10IsM "7a4  .[] 4G4  /68>@GHQ& ) 9 >    4 ouwY._jk`  4 /6a!`4 4  Erik NorgrenDM"c ^`OJQJo(oDMa_` ! 1 4 @ 1dx00L2 @ @$@X@UnknownGz Times New Roman5Symbol3& z ArialG ZapfDingbats BT"qIzIz6wfl l  $24d- - 3H)?a/LKARINTYG fr arbete med joniserande strlning Erik Norgren Erik Norgren Oh+'04 LX t   0LKARINTYG fr arbete med joniserande strlningKA Erik Norgrenr arikrikintyg_joniserande.dotme Erik Norgrenand1ikMicrosoft Word 10.0@Ik@V@'@l'l ՜.+,0$ hp  min-doktor.com- A 0LKARINTYG fr arbete med joniserande strlning Rubrik  "#$%&'()*+,-/012345789:;<=@Root Entry F@s'BData 1Table!WordDocument!0SummaryInformation(.DocumentSummaryInformation86CompObjj  FMicrosoft Word-dokument MSWordDocWord.Document.89q