勘验/检查笔录  
  
  时间____年_____月_____日_____时_____分至_____年_____月_____日______时_____分
  勘验地点/检查对象_____________________________________________________
  检查证或者工作证件号码_________________________________________________
  勘验/检查人员姓名、工作单位、职务(职称)_____________________________
  _______________________________________________________________________
  _______________________________________________________________________
  过程及结果(检查笔录要首先表明是否当场检查)___________________________
  _______________________________________________________________________
  _______________________________________________________________________
  _______________________________________________________________________
  _______________________________________________________________________
  勘验/检查人(签名):_________________________________________________
  记录人(签名):_______________________________________________________
  被检查人或者见证人(签名):___________________________________________