{"id":305,"date":"2026-09-17T21:58:06","date_gmt":"2026-09-17T12:58:06","guid":{"rendered":"https:\/\/supple-log.com\/?page_id=305"},"modified":"2026-09-17T21:58:06","modified_gmt":"2026-09-17T12:58:06","slug":"care-submit","status":"publish","type":"page","link":"https:\/\/kaigospotnote.jp\/?page_id=305","title":{"rendered":"\u52e4\u52d9\u8a18\u9332\u3092\u66f8\u304f"},"content":{"rendered":"<div class=\"ksn\"><header class=\"ksn-header\"><a class=\"ksn-brand\" href=\"https:\/\/kaigospotnote.jp\/\"><span class=\"ksn-logo\" aria-hidden=\"true\">\u25a4<\/span><span><small>\u50cd\u3044\u305f\u65e5\u306e\u3001\u78ba\u304b\u306a\u624b\u304c\u304b\u308a\u3002<\/small>\u4ecb\u8b77\u30b9\u30dd\u30c3\u30c8\u52e4\u52d9\u30ce\u30fc\u30c8<\/span><\/a><nav class=\"ksn-primary-nav\" aria-label=\"\u52e4\u52d9\u30ce\u30fc\u30c8\u306e\u30e1\u30cb\u30e5\u30fc\"><a class=\"ksn-nav-item\" href=\"https:\/\/kaigospotnote.jp\/?page_id=303\"><svg viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"1.7\" stroke-linecap=\"round\" stroke-linejoin=\"round\" aria-hidden=\"true\"><circle cx=\"10.5\" cy=\"10.5\" r=\"6.5\"\/><path d=\"m16 16 5 5\"\/><\/svg><span>\u65bd\u8a2d\u3092\u63a2\u3059<\/span><\/a><a class=\"ksn-nav-item ksn-nav-write\" href=\"https:\/\/kaigospotnote.jp\/?page_id=305\"><svg viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"1.7\" stroke-linecap=\"round\" stroke-linejoin=\"round\" aria-hidden=\"true\"><path d=\"M14 4H5a2 2 0 0 0-2 2v13a2 2 0 0 0 2 2h13a2 2 0 0 0 2-2v-9M14 4l4-3 4 4-3 4-9 9-4 1 1-4z\"\/><\/svg><span>\u52e4\u52d9\u8a18\u9332\u3092\u66f8\u304f<\/span><\/a><a class=\"ksn-nav-item\" href=\"https:\/\/kaigospotnote.jp\/?page_id=306\"><svg viewBox=\"0 0 24 24\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"1.7\" stroke-linecap=\"round\" stroke-linejoin=\"round\" aria-hidden=\"true\"><circle cx=\"12\" cy=\"7\" r=\"4\"\/><path d=\"M4 22v-3a8 8 0 0 1 16 0v3\"\/><\/svg><span>\u30de\u30a4\u30da\u30fc\u30b8<\/span><\/a><\/nav><\/header><main class=\"ksn-main\"><span class=\"ksn-eyebrow\">SHARE YOUR EXPERIENCE<\/span><h1>\u50cd\u3044\u305f\u65e5\u306e\u8a18\u9332\u3092\u6b8b\u3059<\/h1><p class=\"ksn-lead\">\u3042\u306a\u305f\u81ea\u8eab\u304c\u7d4c\u9a13\u3057\u305f\u52e4\u52d9\u306b\u3064\u3044\u3066\u6559\u3048\u3066\u304f\u3060\u3055\u3044\u3002<\/p><div class=\"ksn-info\">\u6c0f\u540d\u30fb\u75c5\u72b6\u30fb\u500b\u5225\u306e\u4ecb\u8b77\u5185\u5bb9\u30fb\u5185\u90e8\u8cc7\u6599\u306f\u5165\u529b\u3057\u306a\u3044\u3067\u304f\u3060\u3055\u3044\u3002\u6295\u7a3f\u306f\u78ba\u8a8d\u5f8c\u306b\u516c\u958b\u3057\u307e\u3059\u3002 \u52e4\u52d9\u5e74\u6708\u3084\u4ed5\u4e8b\u5185\u5bb9\u304b\u3089\u3001\u6295\u7a3f\u8005\u304c\u5206\u304b\u308b\u53ef\u80fd\u6027\u304c\u3042\u308a\u307e\u3059\u3002<\/div><form class=\"ksn-form\" action=\"https:\/\/kaigospotnote.jp\/wp-admin\/admin-post.php\" method=\"post\" enctype=\"multipart\/form-data\"><input type=\"hidden\" name=\"action\" value=\"ksn_preview_record\"><input type=\"hidden\" name=\"record_id\" value=\"0\"><input type=\"hidden\" name=\"ksn_proof_restore\" value=\"\"><input type=\"hidden\" id=\"ksn_nonce\" name=\"ksn_nonce\" value=\"c10075f457\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F305\" \/><div class=\"ksn-honeypot\" aria-hidden=\"true\"><label>\u3053\u306e\u6b04\u306f\u5165\u529b\u3057\u306a\u3044\u3067\u304f\u3060\u3055\u3044<input name=\"website_check\" tabindex=\"-1\" autocomplete=\"off\"><\/label><\/div><fieldset><legend><span>01<\/span> \u52e4\u52d9\u306e\u57fa\u672c\u60c5\u5831<\/legend><label class=\"ksn-field\">\u65bd\u8a2d\u30fb\u4e8b\u696d\u6240\u540d<span class=\"ksn-required\">\u5fc5\u9808<\/span><input type=\"text\" name=\"facility_name\" value=\"\" maxlength=\"100\" placeholder=\"\u65bd\u8a2d\u30fb\u4e8b\u696d\u6240\u540d\u3092\u5165\u529b\" list=\"ksn-facility-suggestions\" autocomplete=\"off\" required><datalist id=\"ksn-facility-suggestions\"><option value=\"\uff08ASPARK\u592a\u7530\uff09\u30b1\u30a2\u30b9\u30c6\u30fc\u30b7\u30e7\u30f3\u592a\u7530Ringwith\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\uff08ASPARK\u971e\u30f6\u4e18\uff09\u30b1\u30a2\u30b9\u30c6\u30fc\u30b7\u30e7\u30f3\u971e\u30f6\u4e18Ringwith\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"HIBISU\u59eb\u91cc\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"HIBISU\u72ed\u5c71\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u3048\u3044\u308b\u3044\u304d\u3044\u304d\u306f\u3046\u3059\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u969c\u5bb3\u798f\u7949\"><\/option><option value=\"\u30a8\u30bf\u30cb\u30c6\u30a3\u5e73\u91ce(\u304a\u3088\u3073\u30d7\u30ec\u30a4\u30b9\u5e73\u91ce\u8a2a\u554f\u4ecb\u8b77\u4e8b\u696d\u6240)\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u30a8\u30bf\u30cb\u30c6\u30a3\u6df1\u4e95\uff08\u304a\u3088\u3073\u30d7\u30ec\u30a4\u30b9\u6df1\u4e95\u8a2a\u554f\u4ecb\u8b77\u4e8b\u696d\u6240\uff09\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u30b0\u30eb\u30fc\u30d7\u30db\u30fc\u30e0\u3000\u307f\u3084\u3073\u306e\u3082\u308a\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u30b0\u30eb\u30fc\u30d7\u30db\u30fc\u30e0\"><\/option><option value=\"\u30b0\u30eb\u30fc\u30d7\u30db\u30fc\u30e0\u30bd\u30e9\u30b9\u30c8\u307e\u306a\u304b\u583a\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u30b0\u30eb\u30fc\u30d7\u30db\u30fc\u30e0\"><\/option><option value=\"\u30b8\u30fb\u30a2\u30fc\u30eb\uff08\u6148\u4e9c\u7559\uff09\u65ed\u30f6\u4e18\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u30b5\u30fc\u30d3\u30b9\u4ed8\u304d\u9ad8\u9f62\u8005\u5411\u3051\u4f4f\u5b85\"><\/option><option value=\"\u30b7\u30cb\u30a2\u30b3\u30fc\u30c8\u5fb3\u6d32\u4f1a\u5929\u7f8e\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u30cf\u30fc\u30e2\u30cb\u30fc\u7fbd\u66f3\u91ce\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u30d1\u30ea\u30a2\u30c6\u30a3\u30d6\u30b1\u30a2\u30db\u30fc\u30e0\u307b\u3057\u306e\u5cb8\u548c\u7530\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u30b5\u30fc\u30d3\u30b9\u4ed8\u304d\u9ad8\u9f62\u8005\u5411\u3051\u4f4f\u5b85\"><\/option><option value=\"\u30d4\u30e5\u30a2\u30cd\u30b9\u516b\u5c3e\u4e2d\u7530\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u30d4\u30e5\u30a2\u30cd\u30b9\u9ad8\u898b\u306e\u91cc\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u30d5\u30a9\u30fc\u30e6\u30fc\u9580\u771f\u306a\u307f\u306f\u3084\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u307f\u3069\u308a\u30b1\u30a2\u30b9\u30c6\u30fc\u30b7\u30e7\u30f3\uff08\u8a2a\u554f\u5148\uff1a\u30d3\u30d0\u30ea\u30fc\u30d2\u30eb\u30ba\u5357\u52a0\u8cc0\u5c4b\uff09\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u8a2a\u554f\u4ecb\u8b77\"><\/option><option value=\"\u30e9\u30a4\u30d5\u30db\u30fc\u30d7 \u5bdd\u5c4b\u5ddd2\u756a\u9928\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u4f4f\u5b85\u578b\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\u3000\u304a\u3060\u8358\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u4f4f\u5b85\u578b\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\u3000\u30b1\u30a2\u30b3\u30fc\u30c8\u72ed\u5c71\u5317\uff08\u6240\u5c5e:\u30b1\u30a2\u30b3\u30fc\u30c8\uff09\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u4f4f\u5b85\u578b\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\u30bd\u30e9\u30b9\u30c8\u9ad8\u77f3\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u5bcc\u7530\u6797\u5e02\u4ecb\u8b77\u8001\u4eba\u4fdd\u5065\u65bd\u8a2d\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u4ecb\u8b77\u8001\u4eba\u4fdd\u5065\u65bd\u8a2d\"><\/option><option value=\"\u7279\u5225\u990a\u8b77\u8001\u4eba\u30db\u30fc\u30e0\u3000\u30cf\u30fc\u30e2\u30cb\u30fc\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u7279\u5225\u990a\u8b77\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><option value=\"\u7279\u5225\u990a\u8b77\u8001\u4eba\u30db\u30fc\u30e0\u5e78\u697d\u306e\u91cc\u306d\u3084\u5ddd\" label=\"\u5927\u962a\u5e9c\" data-service=\"\u7279\u5225\u990a\u8b77\u8001\u4eba\u30db\u30fc\u30e0\"><\/option><\/datalist><small>\u5165\u529b\u4e2d\u306b\u5019\u88dc\u304c\u51fa\u305f\u5834\u5408\u306f\u3001\u767b\u9332\u6e08\u307f\u306e\u65bd\u8a2d\u540d\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044\u3002\u5019\u88dc\u306b\u306a\u3044\u5834\u5408\u306f\u3001\u305d\u306e\u307e\u307e\u5165\u529b\u3059\u308b\u3068\u65b0\u898f\u65bd\u8a2d\u3068\u3057\u3066\u4fdd\u5b58\u3055\u308c\u307e\u3059\u3002\u30ab\u30a4\u30c6\u30af\u30fb\u30bf\u30a4\u30df\u30fc\u306e\u52df\u96c6\u753b\u9762\u306b\u8868\u793a\u3055\u308c\u3066\u3044\u308b\u65bd\u8a2d\u540d\u3092\u3001\u305d\u306e\u307e\u307e\u5165\u529b\u3057\u3066\u304f\u3060\u3055\u3044\u3002\u7565\u79f0\u30fb\u8077\u54e1\u540d\u30fb\u5229\u7528\u8005\u540d\u306f\u5165\u529b\u3057\u306a\u3044\u3067\u304f\u3060\u3055\u3044\u3002\u904b\u55b6\u78ba\u8a8d\u5f8c\u306b\u65bd\u8a2d\u30da\u30fc\u30b8\u3078\u53cd\u6620\u3057\u307e\u3059\u3002<\/small><\/label><label class=\"ksn-field ksn-facility-service\">\u30b5\u30fc\u30d3\u30b9\u7a2e\u5225<span class=\"ksn-optional\">\u4efb\u610f<\/span><select name=\"facility_service\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"\u7279\u5225\u990a\u8b77\u8001\u4eba\u30db\u30fc\u30e0\">\u7279\u5225\u990a\u8b77\u8001\u4eba\u30db\u30fc\u30e0<\/option><option value=\"\u4ecb\u8b77\u8001\u4eba\u4fdd\u5065\u65bd\u8a2d\">\u4ecb\u8b77\u8001\u4eba\u4fdd\u5065\u65bd\u8a2d<\/option><option value=\"\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0\">\u6709\u6599\u8001\u4eba\u30db\u30fc\u30e0<\/option><option value=\"\u30b5\u30fc\u30d3\u30b9\u4ed8\u304d\u9ad8\u9f62\u8005\u5411\u3051\u4f4f\u5b85\">\u30b5\u30fc\u30d3\u30b9\u4ed8\u304d\u9ad8\u9f62\u8005\u5411\u3051\u4f4f\u5b85<\/option><option value=\"\u30b0\u30eb\u30fc\u30d7\u30db\u30fc\u30e0\">\u30b0\u30eb\u30fc\u30d7\u30db\u30fc\u30e0<\/option><option value=\"\u30c7\u30a4\u30b5\u30fc\u30d3\u30b9\">\u30c7\u30a4\u30b5\u30fc\u30d3\u30b9<\/option><option value=\"\u8a2a\u554f\u4ecb\u8b77\">\u8a2a\u554f\u4ecb\u8b77<\/option><option value=\"\u8a2a\u554f\u770b\u8b77\">\u8a2a\u554f\u770b\u8b77<\/option><option value=\"\u969c\u5bb3\u798f\u7949\">\u969c\u5bb3\u798f\u7949<\/option><option value=\"\u305d\u306e\u4ed6\">\u305d\u306e\u4ed6<\/option><option value=\"\u308f\u304b\u3089\u306a\u3044\">\u308f\u304b\u3089\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field ksn-facility-address\" hidden>\u65bd\u8a2d\u30fb\u4e8b\u696d\u6240\u306e\u4f4f\u6240<span class=\"ksn-optional\">\u4efb\u610f<\/span><input type=\"text\" name=\"facility_address\" value=\"\" maxlength=\"200\" placeholder=\"\u4f8b\uff1a\u5927\u962a\u5e9c\u5927\u962a\u5e02\u3007\u3007\u533a\u3007\u30071-2-3\" autocomplete=\"street-address\"><small>\u5019\u88dc\u306b\u306a\u3044\u65bd\u8a2d\u540d\u3092\u5165\u529b\u3057\u305f\u5834\u5408\u306f\u3001\u5229\u7528\u3057\u305f\u30a2\u30d7\u30ea\u306e\u65bd\u8a2d\u60c5\u5831\u306b\u8868\u793a\u3055\u308c\u3066\u3044\u308b\u4f4f\u6240\u3092\u5165\u529b\u3067\u304d\u307e\u3059\u3002<\/small><\/label><div class=\"ksn-form-grid\"><label class=\"ksn-field\">\u52e4\u52d9\u5e74\u6708<span class=\"ksn-optional\">\u4efb\u610f<\/span><input type=\"month\" name=\"month\" value=\"\" min=\"2000-01\" max=\"2026-10\"><\/label><label class=\"ksn-field\">\u52e4\u52d9\u6642\u9593<span class=\"ksn-optional\">\u4efb\u610f<\/span><span class=\"ksn-time-input\"><span class=\"ksn-time-part\"><input type=\"number\" name=\"work_start_hour\" value=\"\" min=\"0\" max=\"23\" step=\"1\" inputmode=\"numeric\" placeholder=\"9\" aria-label=\"\u52e4\u52d9\u958b\u59cb\u6642\u523b\u306e\u6642\"><b>\u6642<\/b><input type=\"number\" name=\"work_start_minute\" value=\"\" min=\"0\" max=\"59\" step=\"1\" inputmode=\"numeric\" placeholder=\"00\" aria-label=\"\u52e4\u52d9\u958b\u59cb\u6642\u523b\u306e\u5206\"><b>\u5206<\/b><\/span><span class=\"ksn-time-separator\">\u301c<\/span><span class=\"ksn-time-part\"><input type=\"number\" name=\"work_end_hour\" value=\"\" min=\"0\" max=\"23\" step=\"1\" inputmode=\"numeric\" placeholder=\"9\" aria-label=\"\u52e4\u52d9\u7d42\u4e86\u6642\u523b\u306e\u6642\"><b>\u6642<\/b><input type=\"number\" name=\"work_end_minute\" value=\"\" min=\"0\" max=\"59\" step=\"1\" inputmode=\"numeric\" placeholder=\"00\" aria-label=\"\u52e4\u52d9\u7d42\u4e86\u6642\u523b\u306e\u5206\"><b>\u5206<\/b><\/span><\/span><small>\u52df\u96c6\u306b\u8a18\u8f09\u3055\u308c\u305f\u958b\u59cb\u30fb\u7d42\u4e86\u6642\u523b\u3092\u5165\u529b\u3067\u304d\u307e\u3059\u3002\u4f8b\uff1a9\u664200\u5206\u301c18\u664200\u5206\u3002<\/small><\/label><label class=\"ksn-field\" for=\"ksn-app\">\u5229\u7528\u3057\u305f\u30a2\u30d7\u30ea<span class=\"ksn-required\">\u5fc5\u9808<\/span><select required id=\"ksn-app\" name=\"app\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"caitech\">\u30ab\u30a4\u30c6\u30af<\/option><option value=\"timee\">\u30bf\u30a4\u30df\u30fc<\/option><option value=\"ucare\">Ucare<\/option><option value=\"sharefull\">\u30b7\u30a7\u30a2\u30d5\u30eb<\/option><option value=\"other\">\u305d\u306e\u4ed6<\/option><\/select><\/label><label class=\"ksn-field\">\u4eca\u56de\u306e\u52e4\u52d9\u8077\u7a2e<span class=\"ksn-optional\">\u4efb\u610f<\/span><select name=\"work_occupation\"><option value=\"care\">\u4ecb\u8b77\u58eb<\/option><option value=\"nurse\">\u770b\u8b77\u5e2b<\/option><option value=\"rehab\">\u30ea\u30cf\u8077<\/option><option value=\"other\" selected='selected'>\u305d\u306e\u4ed6\u8077\u7a2e<\/option><\/select><small>\u4fdd\u6709\u8cc7\u683c\u3067\u306f\u306a\u304f\u3001\u4eca\u56de\u5fdc\u52df\u30fb\u52e4\u52d9\u3057\u305f\u52df\u96c6\u306e\u8077\u7a2e\u3092\u9078\u629e\u3057\u3066\u304f\u3060\u3055\u3044\u3002\u4fdd\u6709\u8cc7\u683c\u3068\u7570\u306a\u308b\u8077\u7a2e\u3092\u9078\u3093\u3060\u6295\u7a3f\u3067\u306f\u3001\u5b9f\u52d9\u5e74\u6570\u306f\u8868\u793a\u3057\u307e\u305b\u3093\u3002<\/small><input type=\"hidden\" name=\"occupation\" value=\"\"><\/label><label class=\"ksn-field\" for=\"ksn-first\">\u3053\u306e\u65bd\u8a2d\u3067\u52e4\u52d9\u3057\u305f\u56de\u6570<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-first\" name=\"first\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"first\">\u521d\u56de<\/option><option value=\"repeat\">2\u56de\u76ee\u4ee5\u964d<\/option><\/select><\/label><\/div><\/fieldset><fieldset><legend><span>02<\/span> \u901a\u52e4\u306b\u3064\u3044\u3066<\/legend><div class=\"ksn-commute-form\"><div class=\"ksn-commute-method-field\"><label class=\"ksn-field\" for=\"ksn-actual_commute\">\u5f53\u65e5\u306e\u901a\u52e4\u624b\u6bb5<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-actual_commute\" name=\"actual_commute\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"car\">\u8eca<\/option><option value=\"motorcycle\">\u30d0\u30a4\u30af<\/option><option value=\"bicycle\">\u81ea\u8ee2\u8eca<\/option><option value=\"public\">\u516c\u5171\u4ea4\u901a\u6a5f\u95a2<\/option><option value=\"walk\">\u5f92\u6b69<\/option><option value=\"other\">\u305d\u306e\u4ed6<\/option><\/select><\/label><\/div><div class=\"ksn-commute-conditions\"><label class=\"ksn-field ksn-commute-condition\" data-commute-method=\"car\" hidden>\u8eca\u3067\u901a\u52e4\u3057\u305f\u5834\u5408<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-car_parking\" name=\"car_parking\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"free_parking\">\u53ef\u80fd\uff08\u99d0\u8eca\u5834\u3042\u308a\uff09<\/option><option value=\"paid_parking\">\u53ef\u80fd\uff08\u6709\u6599\u30fb\u30b3\u30a4\u30f3\u30d1\u30fc\u30ad\u30f3\u30b0\u5229\u7528\uff09<\/option><option value=\"not_allowed\">\u4e0d\u53ef<\/option><\/select><\/label><label class=\"ksn-field ksn-commute-condition\" data-commute-method=\"motorcycle\" hidden>\u30d0\u30a4\u30af\u3067\u901a\u52e4\u3057\u305f\u5834\u5408<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-motorcycle_parking\" name=\"motorcycle_parking\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"motorcycle_space\">\u53ef\u80fd\uff08\u30d0\u30a4\u30af\u7f6e\u304d\u5834\u3042\u308a\uff09<\/option><option value=\"bicycle_space\">\u53ef\u80fd\uff08\u99d0\u8f2a\u5834\u3042\u308a\uff09<\/option><option value=\"not_allowed\">\u4e0d\u53ef<\/option><\/select><\/label><label class=\"ksn-field ksn-commute-condition\" data-commute-method=\"bicycle\" hidden>\u81ea\u8ee2\u8eca\u3067\u901a\u52e4\u3057\u305f\u5834\u5408<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-bicycle_parking\" name=\"bicycle_parking\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"allowed\">\u53ef\u80fd<\/option><option value=\"not_allowed\">\u4e0d\u53ef<\/option><\/select><\/label><\/div><div class=\"ksn-commute-note-field\"><label class=\"ksn-field\">\u8eca\u30fb\u30d0\u30a4\u30af\u901a\u52e4\u306b\u95a2\u3059\u308b\u88dc\u8db3<span class=\"ksn-optional\">\u4efb\u610f\u30fb160\u6587\u5b57\u4ee5\u5185<\/span><textarea name=\"parking_note\" rows=\"3\" maxlength=\"160\" placeholder=\"\u99d0\u8eca\u30fb\u99d0\u8f2a\u5834\u6240\u3084\u6ce8\u610f\u70b9\u306a\u3069\"><\/textarea><small>\u79c1\u6709\u5730\u3084\u7121\u65ad\u99d0\u8eca\u306b\u3064\u306a\u304c\u308b\u6848\u5185\u3001\u500b\u4eba\u540d\u306f\u5165\u529b\u3057\u306a\u3044\u3067\u304f\u3060\u3055\u3044\u3002<\/small><\/label><\/div><\/div><\/fieldset><fieldset><legend><span>03<\/span> \u4f11\u61a9\u306b\u3064\u3044\u3066<\/legend><div class=\"ksn-form-grid\"><label class=\"ksn-field\" for=\"ksn-break_as_ad\">\u4f11\u61a9\u6642\u9593\u306f\u52df\u96c6\u306b\u8a18\u8f09\u3069\u304a\u308a\u3067\u3057\u305f\u304b\uff1f<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-break_as_ad\" name=\"break_as_ad\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"yes\">\u306f\u3044<\/option><option value=\"no\">\u3044\u3044\u3048<\/option><\/select><\/label><label class=\"ksn-field ksn-break-actual\">\u5b9f\u969b\u306e\u4f11\u61a9\u6642\u9593\u3092\u8a18\u5165\u3057\u3066\u304f\u3060\u3055\u3044<span class=\"ksn-optional\">\u4efb\u610f<\/span><span class=\"ksn-number-with-unit\"><input type=\"number\" name=\"break_actual\" value=\"\" min=\"0\" max=\"600\" step=\"1\" placeholder=\"\u4f8b\uff1a60\" inputmode=\"numeric\"><b>\u5206<\/b><\/span><small>\u4f11\u61a9\u6642\u9593\u3092\u8a18\u5165\u3067\u304d\u307e\u3059\u3002\u53d6\u308c\u306a\u304b\u3063\u305f\u5834\u5408\u306f0\u5206\u3068\u5165\u529b\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/small><\/label><label class=\"ksn-field\" for=\"ksn-break_interrupt\">\u4f11\u61a9\u9014\u4e2d\u306e\u696d\u52d9\u5bfe\u5fdc<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-break_interrupt\" name=\"break_interrupt\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"yes\">\u3042\u308a<\/option><option value=\"no\">\u306a\u3057<\/option><option value=\"na\">\u4f11\u61a9\u3092\u53d6\u3063\u3066\u3044\u306a\u3044<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field\">\u4f11\u61a9\u306b\u95a2\u3059\u308b\u6ce8\u610f\u4e8b\u9805<span class=\"ksn-optional\">\u4efb\u610f\u30fb300\u6587\u5b57\u4ee5\u5185<\/span><textarea name=\"break_note\" rows=\"4\" maxlength=\"300\" placeholder=\"\u4f11\u61a9\u5834\u6240\u3001\u98df\u4e8b\u3001\u5229\u7528\u6642\u306e\u6ce8\u610f\u70b9\u306a\u3069\"><\/textarea><\/label><\/div><\/fieldset><fieldset><legend><span>04<\/span> \u52e4\u52d9\u524d\u306e\u8aac\u660e<\/legend><div class=\"ksn-form-grid\"><label class=\"ksn-field\" for=\"ksn-flow\">1\u65e5\u306e\u6d41\u308c\u306e\u8aac\u660e<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-flow\" name=\"flow\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"yes\">\u3042\u308a<\/option><option value=\"no\">\u306a\u3057<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field\" for=\"ksn-task\">\u62c5\u5f53\u696d\u52d9\u306e\u8aac\u660e<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-task\" name=\"task\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"yes\">\u3042\u308a<\/option><option value=\"no\">\u306a\u3057<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field\" for=\"ksn-users\">\u5fc5\u8981\u306a\u5229\u7528\u8005\u60c5\u5831\u306e\u8aac\u660e<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-users\" name=\"users\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"yes\">\u3042\u308a<\/option><option value=\"no\">\u306a\u3057<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field\" for=\"ksn-contact\">\u56f0\u3063\u305f\u3068\u304d\u306e\u8cea\u554f\u5148\u306e\u6848\u5185<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-contact\" name=\"contact\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"yes\">\u3042\u308a<\/option><option value=\"no\">\u306a\u3057<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><\/div><\/fieldset><fieldset><legend><span>05<\/span> \u62c5\u5f53\u3057\u305f\u4ed5\u4e8b<\/legend><p class=\"ksn-muted\">\u65bd\u8a2d\u5168\u4f53\u306e\u4eba\u6570\u3067\u306f\u306a\u304f\u3001\u81ea\u5206\u304c\u4ecb\u52a9\u3057\u305f\u4eba\u6570\u3002\u540c\u3058\u4eba\u30923\u56de\u4ecb\u52a9\u3057\u305f\u5834\u5408\u306f\u300c1\u4eba\u300d\u3067\u3059\u3002<\/p><div class=\"ksn-form-grid\"><label class=\"ksn-field\" for=\"ksn-diaper\">\u304a\u3080\u3064\u4ea4\u63db\u3092\u62c5\u5f53\u3057\u305f\u4eba\u6570<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-diaper\" name=\"diaper\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"0\">0\u4eba<\/option><option value=\"1_5\">1\u301c5\u4eba<\/option><option value=\"6_10\">6\u301c10\u4eba<\/option><option value=\"11_20\">11\u301c20\u4eba<\/option><option value=\"21_plus\">21\u4eba\u4ee5\u4e0a<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field\" for=\"ksn-bath\">\u5165\u6d74\u4ecb\u52a9\u3092\u62c5\u5f53\u3057\u305f\u4eba\u6570<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-bath\" name=\"bath\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"0\">0\u4eba<\/option><option value=\"1_5\">1\u301c5\u4eba<\/option><option value=\"6_10\">6\u301c10\u4eba<\/option><option value=\"11_20\">11\u301c20\u4eba<\/option><option value=\"21_plus\">21\u4eba\u4ee5\u4e0a<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field\" for=\"ksn-meal\">\u98df\u4e8b\u4ecb\u52a9\u306e\u62c5\u5f53<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-meal\" name=\"meal\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"yes\">\u3042\u308a<\/option><option value=\"no\">\u306a\u3057<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field\" for=\"ksn-recording\">\u8a18\u9332\u65b9\u6cd5<span class=\"ksn-optional\">\u4efb\u610f<\/span><select id=\"ksn-recording\" name=\"recording\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"paper\">\u7d19<\/option><option value=\"tablet\">\u30bf\u30d6\u30ec\u30c3\u30c8<\/option><option value=\"pc\">PC<\/option><option value=\"mixed\">\u4f75\u7528<\/option><option value=\"none\">\u8a18\u9332\u696d\u52d9\u306a\u3057<\/option><option value=\"unknown\">\u899a\u3048\u3066\u3044\u306a\u3044<\/option><\/select><\/label><\/div><\/fieldset><fieldset><legend><span>06<\/span> \u307e\u305f\u3001\u3053\u3053\u3067\u50cd\u304d\u305f\u3044\uff1f<\/legend><label class=\"ksn-field\" for=\"ksn-return\">\u540c\u7a0b\u5ea6\u306e\u52e4\u52d9\u6761\u4ef6\u306a\u3089\u3001\u307e\u305f\u50cd\u304d\u305f\u3044\u3067\u3059\u304b\uff1f<span class=\"ksn-required\">\u5fc5\u9808<\/span><select required id=\"ksn-return\" name=\"return\"><option value=\"\">\u9078\u3093\u3067\u304f\u3060\u3055\u3044<\/option><option value=\"yes\">\u50cd\u304d\u305f\u3044<\/option><option value=\"neutral\">\u3069\u3061\u3089\u3068\u3082\u3044\u3048\u306a\u3044<\/option><option value=\"no\">\u50cd\u304d\u305f\u304f\u306a\u3044<\/option><\/select><\/label><label class=\"ksn-field\">\u52e4\u52d9\u4f53\u9a13<span class=\"ksn-optional\">\u4efb\u610f\u30fb200\u6587\u5b57\u4ee5\u5185<\/span><textarea name=\"comment\" rows=\"4\" maxlength=\"200\" placeholder=\"\u5f53\u65e5\u7d4c\u9a13\u3057\u305f\u3001\u4e8b\u524d\u306b\u77e5\u3063\u3066\u304a\u304f\u3068\u5f79\u7acb\u3064\u3053\u3068\"><\/textarea><\/label><label class=\"ksn-field\">\u6301\u3061\u7269\u3084\u5f53\u65e5\u306e\u7559\u610f\u4e8b\u9805<span class=\"ksn-optional\">\u4efb\u610f\u30fb200\u6587\u5b57\u4ee5\u5185<\/span><textarea name=\"caution_note\" rows=\"4\" maxlength=\"200\" placeholder=\"\u6301\u53c2\u3057\u305f\u307b\u3046\u304c\u3088\u3044\u7269\u3001\u305d\u306e\u4ed6\u306e\u6ce8\u610f\u4e8b\u9805\"><\/textarea><small>\u8077\u54e1\u540d\u30fb\u5229\u7528\u8005\u540d\u30fb\u65bd\u8a2d\u306e\u5185\u90e8\u60c5\u5831\u306b\u3064\u306a\u304c\u308b\u5185\u5bb9\u306f\u5165\u529b\u3057\u306a\u3044\u3067\u304f\u3060\u3055\u3044\u3002<\/small><\/label><\/fieldset><section 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