檢查筆錄
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地點_______________________________________________________________
復查員姓名、單位___________________________________________________
偵查人員姓名、單位_________________________________________________
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檢察人員姓名、單位_________________________________________________
被檢查人訴訟身份、姓名、性別、年齡、住址
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見證人姓名、住址、單位_____________________________________________
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檢查目的___________________________________________________________
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檢查過程及結果_____________________________________________________
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偵查員:______________
檢查人:______________
見證人:______________
記錄人:______________