other: Exp. Date: May have the following equipment in his / her possession: Equipment Start Date End Date Return Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P1131281381ED. Work Restriction / Limitation: Cleared for Food Service: Yes X No Restrictions Comments: N/A

other: Exp. Date: May have the following equipment in his / her possession: Equipment Start Date End Date Return Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P1131281381ED. Work Restriction / Limitation: Cleared for Food Service: Yes X No Restrictions Comments: N/A

Exp. Dale: Exp. Date: Exp. Date: Exp.. Date: Exp. Date: nrilartiletriailiTtheiii3Oataiiiiiii:Ilii ,77:; .- • Start Date End Date 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. !fla;:a-)ciaetaitat7 - Cleared for Food Service: Yes • No Restrictions Comments: N/A MD 07/3

equipment ,other. Exp. Date: AYTPREirgEffirelartlitrriTittailiiiTtiziailiiiiciliiitiU ; • Equipment Start Date End Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL tt: P113121313B1ED. WO 110 • Wir .r. s'ziff : :Xie<; . :fr ; • Cleared for Food Service: Yes X No Restrict

other: Exp. Date: May have the following equipment in his / her possession: Equipment Start Date End Date Return Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. Work Restriction / Limitation: Cleared for Food Service: Yes X No Restrictions Comments: N/A

: _football _basketball _handball stationary equipment • falergiffinagra urS areigiga niiiiig •';' Equipment Start Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. O W m tali Cleared for Food Service: Yes X No Restrictions Comments: N/A 1rtatts:Iriart He

ketball _handball _stationary equipment other: Equipment May have the following equipment In his / her possession: Start Date C-Pap 07/30/249 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. .%i% SERIAL #: P11312813B1ED. Work Restriction I Cleared for Food Service: Yes X No Restrictions Comments: N/A Beaudou

her: Exp. Date: ------ May have the following equipment in his / her possession: Equipment Start D.:\te End Date Return Date C-Pap 07/30i2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL#: P1 1312813B1 ED. Work Restriction / Limitation: Cleared for Food Service: Yes --- x No Restrictions Comments: N

other: Exp. Date: ------ May have the following equipment in his / her possession: Equipment Start Date End Date Return Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL#: P11312813B1ED. Work Restriction / Limitation: Cleared for Food Service: Yes --- x No Restrictions Comments: N/A

e Ixp Date' Exp Date. May have the following equipment in his I her possession: Equipment Star' fl 'e End Date Re:urn Date C-Pap 07- 1L2L, PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE SERIAL s. P1131281381ED Work Restriction / Limitation: Cleared for Food Service. Yes X No Restnctions Comments: N/A MD

ap. Date: Exp. Date: May have the following equipment in his / her possession: Equipment Start C ite End Date Return Date C-Pap 07 ni 19 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. Page 082 of 148 Work Restriction / Limitation: Cleared for Food Service: Yes X No Restrictions

handball stationary e Asp. ent other: Exp. Date: May have the following equipment In his her possession: Equipment Star C-Pap 0rni. 2t, 3 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINF SERIAL #. P11312813B1ED. End Date Return Date Work Restriction! Limitation: Cleared for Food Service X No Restrictions

: _football _basketball _handball stationary equipment • falergiffinagra urS areigiga niiiiig •';' Equipment Start Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. O W m tali Cleared for Food Service: Yes X No Restrictions Comments: N/A 1rtatts:Iriart He

_basketball _handball stationary equipment • falergiffinagra urS areigiga nieig (Mif; •';' Equipment Start Date End Date Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. Cleared for Food Service: Yes X No Restrictions Comments: N/A Health Services Staff • Exp. D

ther: _football _basketball _handball stationary equipment • faletanagra urS areigiga niiiiig •';' Equipment Start Date C-Pap 07/30/2019 PHILIPS RESPIRONICS SYSTEM ONE CPAP MACHINE. SERIAL #: P11312813B1ED. W m tali Cleared for Food Service: Yes X No Restrictions Comments: N/A ttiatts:niart Health