现场检查记录（安全生产行政执法文书（式样））
行政执法-
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| Wed Apr 05 08:00:00 CST 2017
现场检查记录
被检查单位：________________________________________________________
地 址：____________________________________________________________
法定代表人（负责人）：_______ 职务：_______ 联系电话：_______
检查场所：__________________________________________________________
检查时间：_____年_____月_____日_____时_____分至_____日_____时_____分
我们是_____安全生产监督管理局的执法人员_____、_____，证件号码为_____、_____，这是我们的证件（出示证件）。现依法对你单位进行现场检查，请予以配合。
检查情况：______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
检查人员（签名）：_______、________
被检查单位现场负责人（签名）：_____
_____年_____月_____日
共_____页 第_____页
续页
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________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
检查人员（签名）：_______、________
被检查单位现场负责人（签名）：_____
_____年_____月_____日
共_____页 第_____页
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