安全生產監督檢查行政執法文書

現場檢查記錄

被檢查單位：________________________

被檢查場所負責人（簽名）：____________________   檢查場所：__________________________

安全生產監察員（簽名）：_______________________   檢查時間：__________________________

檢查情況：____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

被檢查單位意見：

檢查組人員簽名：               負責人簽名：

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