THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T132
Template Title: Spiritual Emergency / Disturbance Incident Log
Related Research Case IDs / Cluster: Cluster B – Non-Human Guardians & Vocation (Cases 11–20)
Linked Templates / Policies: T126–T131, Duty of Care & Wellbeing Guidelines, Security & Access Policy, Institutional Policies for Relic Stewardship
Date of form: ____ / ____ / ______
Prepared by / Role: _________________________________
Office / Unit: _______________________________________
Country / Location: _________________________________
Confidentiality Level:
Internal only [ ] Restricted [ ] Sacred-Restricted / Sensitive [ ]
Use of this form (tick):
New case / action [ ] Follow-up [ ] Annual review [ ] Archive only [ ]
SECTION 1 – BASIC INCIDENT INFORMATION
1.1 Date and time
-
Date of incident: ____ / ____ / ______
-
Time incident began: ________
-
Time incident ended / stabilised: ________
1.2 Location
-
Site (temple / museum complex): _________________________
-
Building / room / area: _________________________________
-
City / Country: ________________________________________
1.3 Relic or shrine connection
-
Was the incident near a relic or shrine?
[ ] Yes [ ] No [ ] Unsure
If yes, name / code of relic or shrine:
1.4 Type of event (tick all that apply – first impression only)
[ ] Sudden strong fear or panic near relics
[ ] Person saying “voices”, “spirits”, “guardians” are speaking
[ ] Person claiming to be “possessed” or controlled
[ ] Person with very disturbed or confused speech about Dhamma / relics
[ ] Intense crying, shaking, or collapse during ritual
[ ] Person unable to calm down after dream / sign experience
[ ] Other unusual spiritual distress (describe shortly):
____________________________________________________
SECTION 2 – PEOPLE INVOLVED
2.1 Main person in distress
-
Full name (if known): _________________________________
-
Dharma / monastic name (if any): ______________________
-
Status:
[ ] Bhikkhu / Monk [ ] Bhikkhunī / Nun
[ ] Novice [ ] Lay male
[ ] Lay female [ ] Other: ____________________ -
Age (approx., if known): ______
-
Resident / visitor / staff / volunteer: _________________
-
Contact (if appropriate – phone / email):
2.2 Other people directly involved
(helpers, guardians, family, staff, witnesses)
| No. | Name | Role (guardian, staff, visitor, family, etc.) | Contact (if needed) |
|---|---|---|---|
| 1 | |||
| 2 | |||
| 3 | |||
| 4 |
2.3 Responsible duty officer on site
-
Name: _______________________________________________
-
Role: _______________________________________________
SECTION 3 – DESCRIPTION OF INCIDENT
Use calm, simple, neutral words. Do not judge or explain the cause. Just record what happened.
3.1 Short summary (2–4 lines)
3.2 Step-by-step description
-
What was happening just before the incident?
(e.g. chanting, quiet sitting, crowd movement)
-
What was first noticed as a sign of distress?
-
What did the person say or do? (main words / actions)
-
Did the person talk about:
[ ] Devas / spirits / nāgas / yakkhas
[ ] Curses / bad energy
[ ] Special messages from relics
[ ] Harm coming to themselves or others
[ ] Other: _______________________________________
Short note with exact phrases, if possible:
3.3 Emotional and physical signs
At the time of the event, the person seemed:
[ ] Very afraid / panicking
[ ] Very angry or aggressive
[ ] Very sad or hopeless
[ ] Confused / not clear where they were
[ ] Very excited / “high” energy
[ ] Very silent and “frozen”
[ ] Other: _______________________________________
Physical signs (if any, simple words only):
[ ] Rapid breathing
[ ] Shaking / trembling
[ ] Fainting or collapse
[ ] Uncontrolled crying
[ ] Other: _______________________________________
Short note:
SECTION 4 – IMMEDIATE RESPONSE
4.1 Safety check
Was anyone in immediate danger?
-
Person in distress:
[ ] No [ ] Possible [ ] Yes -
Other people / property:
[ ] No [ ] Possible [ ] Yes
If “Possible” or “Yes”, short factual note:
4.2 Actions taken on site (tick all that apply)
[ ] Spoke calmly with person, encouraged slow breathing
[ ] Moved person to quieter, safer space
[ ] Asked crowd to give space / keep silence
[ ] Called senior monastic / spiritual teacher
[ ] Called security / duty officer
[ ] Called family or trusted friend
[ ] Offered water / seat / blanket
[ ] Stopped ritual or reduced sound/light
[ ] Called ambulance / medical emergency number
[ ] Called mental health or crisis service
[ ] Other: __________________________________________
4.3 Supportive words or rituals used
-
Short calm guidance given (e.g. “You are safe here”, “Let us breathe slowly together”, etc.):
-
Any simple chanting or blessing used:
Note: Do not make big promises or say “You are possessed” / “Guardians are angry” in this log. Use neutral language.
SECTION 5 – REFERRAL & FOLLOW-UP PLAN
5.1 Referral decision
Was the person referred to any outside support? (tick all that apply)
[ ] No – incident resolved on site, no further help requested
[ ] Family member / guardian
[ ] Local community leader
[ ] Monastic teacher / preceptor
[ ] Counsellor / therapist
[ ] Doctor / clinic
[ ] Hospital / emergency service
[ ] Mental health team / crisis hotline
[ ] Other: _________________________________________
5.2 Referral details
-
Name of person / service referred to:
-
Contact information / service details:
-
Date and time of referral: ____ / ____ / ______ at ______
-
Who made the referral? (name / role):
5.3 Follow-up plan (inside HSWAGATA)
Will HSWAGATA staff or guardians follow up with the person?
[ ] No further contact planned
[ ] Yes – simple check-in (phone / in person)
[ ] Yes – planned meeting with teacher / senior
[ ] Yes – ongoing support plan needed
Short note on planned follow-up (what, who, when):
SECTION 6 – ADDITIONAL NOTES (SPIRITUAL & PRACTICAL)
6.1 Spiritual content (if relevant)
Did the person say that guardians, spirits, or relics were linked to their distress?
[ ] No
[ ] Yes – short report of words used:
_________________________________________________
How did staff respond? (tick)
[ ] Did not argue or agree; listened calmly
[ ] Encouraged person to rest and seek wise guidance
[ ] Spoke about kindness, ethics, and peace
[ ] Other: _________________________________________
6.2 Links to dreams or signs
Is this incident linked to any dream or sign previously logged?
[ ] No known link
[ ] Yes – T128 entry no.: ____________________________
6.3 Practical lessons for site safety
Did this event show any need to change:
[ ] Crowd control / space management
[ ] Light / sound / heat in the shrine
[ ] Staff training for crisis response
[ ] Access to health or wellbeing support
[ ] Other: _________________________________________
Short note:
SECTION 7 – REVIEW & SIGN-OFF
7.1 Duty officer / first responder
Name: _______________________________________________
Role: _______________________________________________
I confirm that this record is as accurate as possible and uses calm, neutral language.
Signature: ___________________________ Date: ____ / ____ / ______
7.2 Supervisor / Siridantamahāpālaka review (if required)
-
Name: _____________________________________________
-
Role: _____________________________________________
-
Date of review: ____ / ____ / ______
Comments (optional):
Further actions decided:
[ ] No further action
[ ] Staff training or briefing
[ ] Policy review
[ ] Follow-up with person in distress
[ ] Other: __________________________________________
Signature: ___________________________
SECTION 8 – ARCHIVING & LINKED FILES
8.1 File storage
-
Physical file code / box number: ______________________
-
Digital archive path / ID: ____________________________
8.2 Linked forms / records
[ ] T130 Daily Guardianship Duty Roster (same date)
[ ] T131 Night Vigil Attendance Log (if relevant)
[ ] T128 Non-Human Guardian Dream / Sign Log
[ ] Health / medical incident report (code: ____________)
[ ] Security incident report (code: ____________________)
[ ] Duty of care / wellbeing plan (code: ________________)
[ ] Other: _____________________________________________
