（此处印制公安机关名称）
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）：___________________________________________
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