安全生产监督检查行政执法文书
现场检查记录
被检查单位：________________________
被检查场所负责人（签名）：____________________ 检查场所：__________________________
安全生产监察员（签名）：_______________________ 检查时间：__________________________
检查情况：____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
被检查单位意见：
检查组人员签名： 负责人签名：
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