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["附件2"]
["____________“双随机一公开”工作情况统计表（2017年第 __季度）"]
["清单编制情况","市场监管执法事项",null,null,"其他行政执法事项",null,null,"如未全覆盖请说明原因："]
[null,"事项总数","纳入随机抽查清单的事项数","所占比例","事项总数","纳入随机抽查清单的事项数","所占比例"]
[]
["两库建立情况","建立检查对象名录库数量（个）",null,"录入检查对象信息（条）",null,"是否建立并公示执法人员名录库","收录执法人员信息（条）","如未建立请说明原因："]
[]
["机制建立情况","是否制定\n实施细则","工作台账是否健全完善","摇号方式","有无随机摇号系统","是否建立双随机\n信息公开专栏",null,"如未落实请说明原因："]
[]
["责任落实情况","分管领导姓名",null,"职务",null,null,"电话号码",null,"手机号码"]
[null,"联络员姓名",null,"职务",null,null,"电话号码",null,"手机号码"]
["工作开展情况","本季度开展执法检查次数","其中采取随机机制的检查次数","随机抽取执法人员(批次)","随机抽取执法人员(人次)","随机抽取检查对象(批次)","随机抽取检查对象（个）","公示检查结果信息\n（批次）",null,"公示检查结果信息（条）"]
[]
["如有采用双随机机制开展的执法检查行为请说明原因："]
["说明：本表请各县区和市级各有市场监管执法、其他行政执法事项的部门（单位）于每季度次月3日前填报，传真至5280858。"]
["填报单位（盖章）：",null,null,"负责人签名：",null,null,"填表人签名：",null,"填报时间："]