案由:__________________________________________________________调查地点:_______被调查人:_______性别:_______职务:___________被调查人工作单位:________________被调查人联系方式:____________被调查人地址:__________________________________________________调查人:________、________记录人:_________监督检查类别:_______调查时间:_______年______月______日____时_____分至_____时_____分
我们是_______的执法人员_____执法证件名称、编号是:________________我们依法向你调查_______________________________有关问题,请予配合。
调查记录:
______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________
注:被调查人在调查笔录上逐页签字,在修改处签字或者按指纹,并在笔录终了处注明对笔录真实性的意见;调查人应在笔录终了处签字。