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[null,"特定教育訓練実施記録　"]
[null,null,null,null,null,null,null,null,null,null,null,null,"※特定教育訓練終了日から３年間保存"]
[null,null,"特定教育訓練実施記録",null,null,null,null,null,null,null,null,"作成日"]
[null,null,null,null,null,null,null,null,null,null,null,"実施者"]
[]
[null,null,"氏名",null,null,null,null,null,null,"※署名"]
[null,null,"訓練対象職務",null,null,null,"船長",null,"甲板員",null,"その他乗組員"]
[null,null,"上記職務として乗り組む航路",null,null,null,null,null,null,null,null,"※航路図等を添付"]
[null,null,null,"【グループ１及び２の船長候補のみ】"]
[null,null,null,"運航航路の海域において、小型旅客船に、営業運航予定時季と同一の時季を通じて相当の回数、当該船舶に乗り組んだ経験\n及び\n当該海域の特性を十分に理解していることの確認","確認日",null,null,null,null,null,null,"※乗り組み経験の確認書類、確認テストを添付"]
[null,null,null,null,"確認",null,"乗り組み経験",null,"理解度"]
[null,null,null,null,"確認者\n（船舶所有者）"]
[null,null,"上記職務として乗り組む船舶",null,null,null,null,null,null,null,null,"※船舶検査証書等を添付"]
[]
[null,null,"指導者等の選任"]
[null,null,"会社名等"]
[null,null,"経験"]
[null,null,"氏名"]
[]
[null,null,"効果測定"]
[null,null,"実施年月日"]
[null,null,"指導者氏名"]
[null,null,"結果"]
[null,null,null,null,"※効果測定を添付"]
[null,null,"最終確認"]
[null,null,"役職"]
[null,null,"日付"]
[null,null,"氏名"]
[]
[null,null,"備考"]
[]
[]
[]
[]
[null,null,"実施状況については別紙"]

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[null,"記載例"]
[null,"特定教育訓練実施記録　"]
[null,null,null,null,null,null,null,null,null,null,null,null,"※特定教育訓練終了日から３年間保存"]
[null,null,"特定教育訓練実施記録",null,null,null,null,null,null,null,null,"作成日","2024-04-01"]
[null,null,null,null,null,null,null,null,null,null,null,"実施者","船舶所有者名"]
[]
[null,null,"氏名",null,null,"〇〇",null,null,null,"※署名"]
[null,null,"訓練対象職務",null,null,null,"船長",null,"甲板員",null,"その他乗組員"]
[null,null,"上記職務として乗り組む航路",null,null,"B航路（同等の航路：A航路）",null,null,null,null,null,"※航路図等を添付"]
[null,null,null,"【グループ１及び２の船長候補のみ】"]
[null,null,null,"運航航路の海域において、小型旅客船に、営業運航予定時季と同一の時季を通じて相当の回数、当該船舶に乗り組んだ経験\n及び\n当該海域の特性を十分に理解していることの確認","確認日","2024-04-01"]
[null,null,null,null,"確認",null,"乗り組み経験",null,"理解度",null,null,"※乗り組み経験の確認書類、確認テストを添付"]
[null,null,null,null,"確認者\n（船舶所有者）","〇〇〇〇"]
[null,null,"上記職務として乗り組む船舶",null,null,"A船舶（同等の船舶：B船舶）",null,null,null,null,null,"※船舶検査証書等を添付"]
[]
[null,null,"指導者等の選任"]
[null,null,"会社名等",null,"自社","自社",null,"自社"]
[null,null,"経験",null,"５年","３年",null,"２年"]
[null,null,"氏名",null,"〇〇","〇〇",null,"〇〇"]
[]
[null,null,"効果測定"]
[null,null,"実施年月日",null,"2024-06-05","2024-06-05",null,"2024-06-05"]
[null,null,"指導者氏名",null,"〇〇","〇〇",null,"〇〇"]
[null,null,"結果",null,"合格","合格",null,"合格"]
[null,null,null,null,"※効果測定を添付"]
[null,null,"最終確認"]
[null,null,"役職",null,"船舶所有者","安全統括管理者",null,"運航管理者"]
[null,null,"日付",null,"2024-06-10","2024-06-09",null,"2024-06-08"]
[null,null,"氏名",null,"※署名","※署名",null,"※署名"]
[]
[null,null,"備考"]
[null,null,"・特例を適用\n適用内容：　運航海域の乗り組み経験の省略\n適用した理由：　新規航路開設に向けて、５月１日から１か月間、〇〇において求人募集を行ったが、該当者の確保ができなかったため"]
[]
[]
[]
[null,null,"実施状況については別紙"]
[]
[null,null,"以下、備考の例"]
[null,null,"・特例を適用\n適用内容：　訓練時間・回数の半減\n適用した理由：　概ね同じ航路に従事する他社からの転職者につき、確認テストを行ったところ評価が８割だったため。"]
[]
[]
[null,null,"・特例を適用\n適用内容：　運航海域の乗り組み経験の省略及び訓練時間・回数について任意の回数とすること\n適用した理由：　海上保安庁職員による灯台等メンテナンスのための作業通船であるため。"]
[]
[]
[null,null,"・特例を適用\n適用内容：　運航海域の乗り組み経験の省略及び訓練時間・回数について特例の回数とすること\n適用した理由：　令和６年８月２日の海上花火大会のためのスポット運航であるため。"]