Kwestionariusz Wywiadu Środowiskowego Część I
Kwestionariusz Wywiadu Środowiskowego Część I
;
)*+),-. ")/)%0
1")2$%&3$4 567
"+&$,1#'7#)+189.
"),/#)86
5$%&3#%&$:)
<=>;?@ABCD@E;F
DAGF@BB>HA =I=@CGE JDAGA=@;<A=>HA
KFLJM @
GA?IKFI A;NO EO@>HCPQKIKR ;@L A SDFIFBCB@> J=@CGKF>T SAUAKI ;SAV>KFB>P
!
!"#$%&'()*+,"&"*-.&$/)*0"'&1-2$3" "
" " " " " "
" 4" 5" 6" 7" 8" 9"
?)@)"A'&1-,$2)" F@&;2,H"
:;!" F@)$" ;&/',=2,HI"
#(2<"2"$)-=2>/&" B.,C" D'"BEFE:"
1-2,H" (2,>!" '&/" *3=2G$3"
>@=)"
"
J" " " " " " " " "
"
" " " " " " " " "
""4"
"
" " " " " " " " "
""5"
"
" " " " " " " " "
""6"
"
" " " " " " " " "
""7"
"
" " " " " " " " "
""8"
"
" " " " " " " " "
""9"
"
" " " " " " " " "
""K"
"
" " " " " " " " "
""L"
"
" " " " " " " " "
" M"
"
" " " " " " " " "
" "
"
" " " " " " " " "
" 4"
"
" " " " " " " " "
" 5"
"
" " " " " " " " "
" 6"
"
"""""J"D)G,N3"=;2>)C"1)$,"&>&O3P"-"/@Q'R";'-,;'&=)1-&$&"=3=2)1!"
"""""S =) T ) U "" !"V11-2,G$,"T&>;&1)'>@=)"1&(&=,"$)G,N3"&1-$)*-3C";&-2&(R"/',>/R!"
"""""""""""""""""""""""""""""""""""""4!"W";'-3;)1/A"=2</>-,+"G2*-O3"&>QO"="'&1-2$2,""$)G,N3"1&.R*-3C"1&1)@/&=,">@'&$3!"
4"
"
" # $% $$ $& $!
'() *+,-./01234536 ;53<-23 (=02+ >?@ 40?,5 C8.+2<0 D+/?02<0 E=9:18 :82F8:? A?/=.+G0450B
7+,84+704+ .079: A-.,8106 (=.3:-.,8>3B 40 =+4,? .:=878/40
(=02+ =8:.0< 7+-8,8HI
&
"
$%
$$
$&
$!
$J
!
"# $%&' & ()*+&,-./ ,0.1&23 1.-42+&23,0+) .4)* )542,6 .,78/ . -07469: %.+) + )40; "<= >,0)+6 * 5(&) "# %)49)
#<<! 4; . 1.%.96 ,1.?29*(2@/ +&2A-.BC & D.4%) B+&)59*.(2@ A>8 52-A)4.+)(2@ 1.%.96E
"= FG9*(6 5.9:75 + 4.5*&(&2 H*I.5(&2 * )40; J >,0)+6 * 5(&) "# %)49)
#<<! 4; . 1.%.96 ,1.?29*(2@K
"! L0)?2/ %&2,&'9*(2 +65)0-& .,.86M4.5*&(6 ?G9*(&2E *?
+ 06%E 9*6(,* *?
2(24I&) 2A2-0469*() *?
I)* *?
)A&%2(06 *?
.1?)06 *) ,*-.?'M8>4,'M&(024()0 *?
.1?)06 *) 14*25,*-.A2 *?
&((2 N @)-&2O *?
"P QA&%2(06 B+&)59*.(2 14*2* .,.8'/ * -074G @2,0 14*214.+)5*)(6 +6+&)5/ A>8 &((69: 9*?.(-7+ 4.5*&(6E
R0.O
S) 9*6@G 4*29* O
!
""# $%&'()*( +",$-.(/"01( 0$02%3405-"/%
e &X# JSBKOA ;GHKDOM;< M@;HX >J>DGH =CD B>MKG;GH M> SB>:@MKH;G@L : IG@BO I>b=G:>EFGL J@I>MKGH=;HT> T>JS>M@BJA:@ M>I>:HT>#
!
!!!" #$%&'()' *+,-!..' +#/0 1#2/3.!4 -'5!4#-6&)7($(8
9 6:; < =<>;?@AB C;D<E?F E DGH=<IJ;K LEL; BMNAG?IJ; <HLEIM<@EBH?EHK NC;BHD<E ;DD<EIG?I J;MN;DHCM:B;
D;L;BIO
)IZIGE :H@K :; =<F YF>F GRY MT N;DISL;BH?I NCAYF E=_ C;<BET<H?EH" )H@EIO
)H@EI N;DSQ:; D<EH>H?EHO b(<F BM<=<Q:; NC;=IDRCQ c.EIYEIM@EIS 6HC:FdO (<F N;B;>H?; B :IS MNCHBEI <IMNA>
E?:ICDFM=FNGE?HC?F GRY JCRNQ C;Y;=<TOW
!
" #$%&'()%)*+%,- .)/0,%1 * 2.)/)*,3&$ , 0+4.)5-%,+ 0- 36.)%1 2.)/)*,3&+
K ;01 &6)2 0 '0?)%&L* .)/0,%1 &).0136+ 8$< &).0136+? 0 $3?$4 )2.)/&+ *3:+.',+E AB 6+&
/)>$ :)>)'1 3:)?-'0%-( 8$< :8+'L*&, ):,-&$M'0)N*1'O)*+*'0-(E :.0-<1*+ 8$< CB %,-
:.0-<1*+? * 0+&?+/0,- :):.+*'01>E 3'O.)%,3&$ /8+ %,-8-6%,'OE 3:-'(+8%1> )2.)/&$
30&)8%)N*1'O)*+*'01>E 3:-'(+8%1> )2.)/&$ *1'O)*+*'01>E >?)/0,-5)*1>
)2.)/&$ *1'O)*+*'01>E >?)/0,-5)*1> )2.)/&$ 3)'()6-.+:,, 8$< ,%%-( :8+'L*'-
3136->$ )2*,+61F
D-5-8, 6+&E 6) 0 (+&,-4) .)/0+($
:8+'L*&,FPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
Q/.-3@ PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
R ;01 &6)2 0 '0?)%&L* .)/0,%1 :.0-<1*+ 8$< :.0-<1*+? * 0+&?+/0,- &+.%1>@ AB 6+&
CB %,-
Q/.-3@ PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
D-5-8, :.0-<1*+E 6) '01 (-36 0+6.$/%,)%1 , '01 (-4) 0+.)<&, 3S :.0-&+01*+%- .)/0,%,-@ AB 6+&
CB %,-
*13)&)29 (+& '0G36)
!
"#$ %&'()*+) ,)-./.-)
)$ %0123453 67680 89:;6861<95
= > ? @ A B C !
,3;959I S;3H M;3G3
71;6G3<0J<3K L6 :37EOH2 P28
"DEF E <3:GE7H6 (1;34EOJ3K M;3G6 L6 :37EOH2
G 2;:FL:E9 N68E9;3 :37EO9H P28 E<<9 QGE3L4:9<E9 E<<9R6
P28 E<<9R6 QGE3L4:9<E3
M;340 QGE3L4:9<E3
;6L:35
=K 13H =K 13H E G076H6QT =K 13H
6L HE9L0 =K 13H 6L HE9L0
>K <E9 >K <E9 :37EOH2 P28 >K <E9
E<<9R6 >K <E9
QGE3L4:9<E3 DE97$ ;6H DE97$ ;6H
S$ UG3PEVEH3459W 2DE95F1<6Q4E 6;3: L6QGE3L4:9<E9 :3G6L6G9 D6RX49 80T M;:0L31<9 M;:0 M67:2HEG3<E2 M;340
J<M$ M;3G6 53:L0W 2M;3G<E9<E3 L6 G0H6<0G3<E3 6H;9QP6<04Y M;34K
!
"# $%&'()*( +,-./.&0(
(# $1234564 789:;:2<4 9:87=<1
> ?=57@4 :AB@ 8C3D:29;4EF 5G:915G -:8746F A5G:97FH
; 21IJ 87=F5=
X ,4<F EFS4974 M:8A24;:;F6 :M=FS= 789:;:2<F6 Y=I=NW <47;=AS:W 489FA I=F6A54 387=FE4<=4 U;=4857FH
789:;:2<15GW 2FEFZ:<RJ
!
#$ %&'()*+) ,-./ 0123240,-35)60&*7
! 8 9 : ; < = > ?
H-')I,0) J5(3) Q25A10
106)I1FCD)K P5C2*C2012 3,61)',62J,
D,I2+02J,
-',312L 0123240,M C2-3,4( F-$ ,5C2D)01) R&01D ,5C2*C201)
/)F)01)
-35)60,N*1K , 0123240,-35)60,N*1
012CF,I0,NO F, 6-D)C)M
@A1B 1 0)C61-D, E,FC)+
-)A,FC12I02+ F)') 01) F,
F&-G(0D*+1 2JC&-'20*+1 I(/ PJ5)01*C201) G(0D*+,0)I02
-',312L 35)*&
012CF,I0,NO F, 0(A25 A12-$ 5,D 0123240,M
35)*& -35)60,N*1
A12-$ 5,D
!S ')D /5)D
8S 012 6-D)C)L
!"
! "#$%& ' ()$* +,-.-/+().%&0+123 014,-+,(+& 0 2'562, 7 014&8&9
@: +,-
M E(FG,0(6H '&.-0+,-+,& .(4(21 '- )#%(+1 >-<+()#-; (%8&+,'&21>+123 .(4(21 ).(/-2'+-> 84,+1 , .(0,&#B =I(%4&
, '&;%-) .(4(21:9
@: 2&/;(0,2,-
!!
#$ %&'()*+) ,-./ (0)12345,4&*6 ,7 )18,6,1( 1(/ 4)98,'&8.:
! " ; < = > ?
G527& D,7+B',
12*02452F #0& ,-,/)
#0& D,7+B',
(0)12345,4)
12*02452
:&9)3) 0H,7B
C,70)+ 5 -',D52E ,7:&8,:2F
@A5B 5 4)0:5-8, 4) D,7+B*52 I23215 452J ', 71)*02H,F K:)H5
(0)12345245)
12*0245)F
!"#$% &'(
)* +,(
)* +,(
-* ."#
-* ."#
!"
#$% &'()*+,- $ '.*+/$012$1 '3',-4)'5*$2- *67'3*'2+
&'5.*13 &)*+&)'015*12$1 0-0$158
59:9 ;<=>?;@AB9C
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
QG9:9 B D>GDB? >?>YHU ; L:ZEP DE;@DE>F9G;>A> FHFB9GS
$AW>EJ9MN9 > ;<=9?;9NPMHJ DE>YO@J[C
! * IE;KGI \ ;<=>?;@AB@C
!S DE9M>FABL9 ?>MN9OA@<>U
]S BA?:H:IMNB OIY >E<9AB;9MNB QA9;F9U 9GE@?U :@O@W>AS
] 29 FAB>?@LC
!S >?>YH >YM@NU
]S M;=>AL9 E>G;BAH
!"
#$$% &'()* +,-.*'/$ &+&0,12&34$), $ 5)$&+6$ 72*'&5)$6* +&'/*8)(9&
::::::::::::::::::::::::::::::::
;<=><?@ ? <?ABCDE <FGB=HI?JG @=BKGLIAM=N
!"
#$$$% &'() &*+*,- $ ./$(0(1 )( 2/3,/ *4*5- '65 2*./$)-
^@BF<89C:BF :BCOBC:BT_:C
OAF8F J=8QFW:F
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
DO=<OBJ B OBC89Tb OAF8=@:BYF J=8QFW:CE=R
!"
#$% &'() &*+*,- .(/0#123.*)- &2.1. 4#12*0)#4( 513)*6/4#
*27()#.(,-5)15 &*+*,- 6&*81,.)15
!"
#$% &'()*()&+
!"