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):___________________________________________