检查笔录标准版

（此处印制公安机关名称）
检查笔录

    检查时间_____年_____月_____日_____时_____分_____至_____年_____月_____日_____时_____分
    检查人______________    工作单位_____________________________________________
    检查证文号___________________________________________________________________
    检查对象____________________________________________________________________________
    检查过程及情况______________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________
    ____________________________________________________________________________________

　　检查人：__________　记录人：__________
    当事人或者见证人（签名 ）：  _______________