THE HSWAGATA BUDDHA TOOTH RELIC PRESERVATION MUSEUM
FOR INTERNAL USE ONLY
Template No.: T183
Template Title: Community Feedback & Complaint Form
Related Research Case IDs / Cluster: Cluster D (Everyday Faith & Lay Donations), Cases 36–45 (add F if conflict risk; E if misinformation risk)
Linked Templates / Policies: Visitor Service Policy, Safeguarding Policy, Conflict Resolution & Security SOP, Data/Privacy Rules, T165 (Internal Memo), T163 (Risk Register Entry), T173 (Records Classification)
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 [ ]
1) Purpose (why we use this form)
This form receives community feedback or complaints in a safe, respectful way.
We record the issue, the impact, and the response we promise.
2) Person giving feedback (or anonymous)
A) Do you want to stay anonymous? Yes [ ] No [ ]
If No, please fill:
Name: ______________________________________________
Phone: ____________________ Email: ____________________
Address / village (optional): _____________________________
Relationship to HSWAGATA (tick): Visitor [ ] Donor [ ] Local resident [ ] Temple member [ ] Partner [ ] Staff/Volunteer [ ] Other: ____
If Yes (anonymous), do you still want a reply? Yes [ ] No [ ]
If Yes, safe contact method (optional): _______________________________
Consent to contact (tick):
Yes, you may contact me about this issue. [ ]
No, please do not contact me. [ ]
3) Feedback / complaint details
Date of issue (if known): ____ / ____ / ______
Time (if known): __________
Location (place/room/site): ______________________________________
Type of message (tick one):
Feedback / suggestion [ ] Complaint [ ] Safety concern [ ] Donation concern [ ] Staff conduct concern [ ] Other: ______
Topic (tick all that apply):
Visitor service [ ] Cleanliness [ ] Event/community program [ ] Donations/receipts [ ] Information/labels [ ] Access/rules [ ] Security/safety [ ] Online/media issue [ ] Other: ______
4) The issue (what happened)
Describe clearly in your own words (add extra page if needed):
People involved (names/roles if known; optional):
5) Impact (how it affected you or others)
Tick and explain.
Upset feelings / loss of trust [ ]
Financial loss / donation worry [ ]
Safety concern (trip, crowd, fire, etc.) [ ]
Conflict between people/groups [ ]
Disrespect to faith / dignity concern [ ]
Misinformation / false claim concern [ ]
Other impact: ____________________ [ ]
Impact details (short):
6) Urgency and safety check (important)
Is anyone in immediate danger right now? Yes [ ] No [ ]
If Yes: call emergency help first and inform museum security/manager.
Is this about violence, threats, theft, or serious security risk? Yes [ ] No [ ]
Is this about child safety or vulnerable person safety? Yes [ ] No [ ]
If Yes to any: mark Restricted and escalate to the Director/Security/Safeguarding lead.
7) Evidence (optional)
Photo/video provided? Yes [ ] No [ ]
Document/receipt provided? Yes [ ] No [ ]
Witness names/contact (optional): __________________________________
Evidence file location (internal): ____________________________________
8) What result would you like? (optional)
9) Response promised (to be completed by staff)
A) Acknowledgement
Date received: ____ / ____ / ______
Received by (name/role): __________________________________
Method received (tick): In person [ ] Phone [ ] Form box [ ] Email [ ] Social media [ ] Other: ____
B) What we promise now (tick all that apply)
We will review and reply. [ ]
We will investigate and update you. [ ]
We will correct the problem if confirmed. [ ]
We will explain clearly if we cannot do the requested action. [ ]
We will keep your information private as far as possible. [ ]
C) Expected response time (tick one)
Within 3 working days [ ] Within 7 working days [ ] Within 14 working days [ ] Other: ____
D) Responsible person (case owner)
Name/role: ______________________________ Phone/email: ______________________
10) Internal actions (to be completed by staff)
Action 1
Task: _________________________________________________
Owner: __________________________ Deadline: //____
Status: Open [ ] In progress [ ] Done [ ]
Action 2
Task: _________________________________________________
Owner: __________________________ Deadline: //____
Status: Open [ ] In progress [ ] Done [ ]
Outcome / decision (short, factual):
Any policy/SOP update needed? Yes [ ] No [ ]
If Yes, link: T155 [ ] T162 [ ] T169 [ ] Other: ______
Risk register entry needed (T163)? Yes [ ] No [ ] Risk ID: __________
11) Closure (finish the case)
Closed date: ____ / ____ / ______
Closed by (name/role): _______________________________
Message sent to person (if contact allowed)? Yes [ ] No [ ] Date: //____
Person satisfied (if known): Yes [ ] No [ ] Not sure [ ]
12) Signatures and filing
Prepared/received by (name/role): __________________ Signature: __________ Date: //____
Reviewed by (Unit Head/Director if needed): __________ Signature: __________ Date: //____
File code / reference ID: ____________________
Classification recommended (T173): Public [ ] Internal [ ] Restricted [ ] Sacred-Restricted [ ]
File location (cabinet/folder + digital path): __________________________
Retention period: 1 year [ ] 3 years [ ] 5 years [ ] Other: ____
