HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM
DONATION COMPLAINT & RUMOUR REPORT FORM
Form Code: HSW-F35
Case Number: __________________________
Date: ____ / ____ / ______
1. PERSON MAKING REPORT
(Can be confidential; fill what is possible.)
1.1 Name (optional): _________________________
1.2 Contact (phone / email, optional):
_________________________________________
1.3 Relationship to museum:
[ ] Staff [ ] Volunteer
[ ] Donor [ ] Visitor
[ ] Other: ______________________________
2. NATURE OF COMPLAINT / RUMOUR
2.1 Type:
[ ] Misuse of donation
[ ] Broken promise to donor
[ ] False story about donation
[ ] Other: ______________________________
2.2 Summary of complaint / rumour:
_________________________________________
_________________________________________
3. PEOPLE INVOLVED
3.1 Names (if known):
_________________________________________
_________________________________________
4. INITIAL FACTS COLLECTED
4.1 What is already known or checked?
_________________________________________
_________________________________________
4.2 Evidence attached:
[ ] Documents
[ ] Screenshots
[ ] Audio / video
[ ] None
5. IMMEDIATE RESPONSE
(What has been done so far?)
____________________________________________
____________________________________________
6. FOLLOW-UP PLAN
6.1 Suggested actions:
[ ] Talk with donor
[ ] Internal review
[ ] Public clarification
[ ] Other: _____________________________
6.2 Person responsible for follow-up:
_______________________________________
7. SIGNATURES
Case Handler:
Name: ______________________________________
Role: ______________________________________
Signature: _______________ Date: ____/____/____
Supervisor / Manager:
Name: ______________________________________
Signature: _______________ Date: ____/____/____
